The Oft-Overlooked Job Description

Kate SheahanThis post originally appeared on VITAL, the blog of IntraHealth International.

Job descriptions for health workers—it seems like a simple concept. And in fact, job descriptions can increase a community’s access to high-quality health care in low-resource settings.

But many health workers in low-income countries don’t have this basic tool.

For example, only 57% of health workers in Namibia and 38% of health workers in Kenya have job descriptions, according to data from Service Provision Assessments conducted by the countries’ ministries of health.

Research conducted in Kenya shows that health workers who have written job descriptions provide higher-quality care than those who do not. This may be because job descriptions provide structure, guidance, accountability lines, minimum skills and qualifications standards, and performance benchmarks. Read more »

Thoughts on Motivating Health Workers

Maurice MiddlebergThis post was originally published on the IntraHealth International blog.

At the recent Global Health Council Conference, I had the great pleasure of moderating an IntraHealth/CapacityPlus-sponsored event on health worker motivation featuring two extraordinary people: Daniel Pink, the author of the best-selling Drive: The Surprising Truth About What Motivates Us, and Dr. Barbara Stilwell, director of technical leadership at IntraHealth.

Health leaders and managers wrestle constantly with the challenge of motivating health workers. Health workers must be retained, productive, and caring if the huge deficits in access to health workers are to be addressed. Pink and Stilwell brought to bear their very considerable expertise on this question. Read more »

Mind over Matter

Shaun NoronhaCan we condition health workers to believe that they should work in underserved areas? Among the nonmonetary incentives used for retaining workers in rural areas, intrinsic motivation—or inherent willingness—can be a significant influence. The problem with intrinsic motivation is that by definition, it’s intrinsic, and cannot be cultivated or systematically introduced into a cohort of health workers. Or can it?

Cognitive dissonance
A classic study by psychologists Leon Festinger and James Carlsmith (1959) on cognitive dissonance—the phenomenon by which a person states an opinion different from what he or she believes to be true—may hold the answer. Read more »

Three Myths about Health Worker Retention

Maurice MiddlebergHow can we encourage health workers to take up and remain in rural postings? This is a key challenge for increasing access to health care. But as we address health worker retention in hard-to-reach areas, there are numerous myths afloat. Here are just a few.

Myth 1. Health workers leave rural posts because they want more money
To be sure, salaries are important. But it’s more complicated than that.

As my colleague Kate Tulenko has pointed out, health workers are consistently among the top wage earners in developing countries. And in terms of international migration, an OECD policy brief notes that while “wage differentials across countries play an important role,” that’s not the only reason health workers leave. Other factors are also at play.

In a South African study cited in Fatu Yumkella’s brief on retention, for example, doctors noted that improving their salary was one of the most important factors for rural retention—yet they also stated that salary alone would not retain them. Money is only one part of the picture.

Myth 2. International migration is the greatest threat
We often think that developing-country health workers’ migration to the US, UK, and elsewhere is the most pressing challenge we face in addressing the workforce shortage. But it’s less of a concern for rural health care than we might expect. Read more »

From Rural Virginia to Remote Areas of Laos: Keeping Health Workers in the Communities That Need Them

Maurice MiddlebergOn a recent Monday I spotted an article in the Washington Post about a young doctor who accepted a position in rural Virginia. She and many other health workers are struggling to balance their professional commitment—“I really wanted to help people who wouldn’t otherwise get help,” Dr. Sarah Carricaburu told the reporter—with the drawbacks of living far from an urban center. She’s not sure if she’ll stay.

I was struck by the similar context of this article and the stories I hear every week from developing countries around the world. The factors driving doctors and nurses away from rural posts in the US are largely the same as those in developing countries—social and professional isolation, access to the Internet, housing, cultural options, schooling for children, lack of opportunity for continuing education.

We often assume the problem is one of salary. But it’s more complicated than that. Read more »

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