Improving health services: motivating health workers in Mali

If accessibility to health care services and quality of care are to be improved, it is essential to have a workforce that is qualified and motivated. What motivates and demotivates health care workers in Mali? How are the motivators linked to the implementation of performance management?

Motivation at work can be defined as a worker’s degree of willingness to make and maintain an effort towards achieving an organisation’s goals. It is a challenge for managers to create this, as research shows that managers and workers tend to have different perceptions of motivation. Furthermore, little is known about what motivates health staff in poorly resourced work environments.

Motivation can be divided into two areas, according to theorists. The first is a person’s motivation to stay in a job – or alternatively, their demotivation to stay in the job due to dissatisfiers (the main causes of job dissatisfaction). Examples of dissatisfiers are poor working conditions, low salary and poor relationship with colleagues. The second area of motivation is a person’s incentive to perform well due to satisfiers (the main causes of job satisfaction), examples of which are responsibility, recognition and achievement. An organisation should ideally influence satisfiers through measuring, monitoring and enhancing the performance of its staff (performance management).

The Mali Government’s Ministry of Health, in seeking to improve the performance of its health workers, undertook research to identify what factors motivated health staff from eight professional categories – public health doctors and nurses, auxiliary nurses, registered nurses, midwives, laboratory technicians, sanitary technicians and community development workers. By matching the factors to existing performance management activities, it aimed to identify ways to improve the human resources (HR) activities of health services managers.

The study made a number of findings, including:

• The main motivating factors were recognition, responsibility and training, followed by salary.
• These motivating factors can be influenced by improving performance management and by better linking of these activities.
• Activities such as promotion, career development and performance appraisal were seen as administrative procedures rather than being used to boost work performance.
• Job descriptions were not specific enough to identify training needs or to allow staff to feel or be held responsible.
• Health workers viewed their managers’ decisions as lacking in transparency, for example, on performance appraisals and training.

The research shows that it is important to adapt or improve performance management strategies to influence staff motivation. Policy recommendations include:

• Motivation could be improved by giving staff greater responsibility, holding them responsible and improving means of recognition.
• Matching improved performance management activities to the motivating factors identified could increase motivation and lead to improved quality of care and accessibility.
• The factors that motivate health workers in their specific contexts need to be identified before selecting the appropriate HR activities to address them. 
• Performance management could be better focused on the provision of quality, accessible health care.

Source(s):
‘The match between motivation and performance management of health sector workers in Mali’, Human Resources for Health 4:2, by Marjolein Dieleman, Jurrien Toonen, Hamadassalia Toure and Tim Martineau, 2006 Full document.

Funded by: The European Commission

id21 Research Highlight: 13 September 2006

Further Information:
Marjolein Dieleman
KIT Development, Policy and Practice
Royal Tropical Institute
Amsterdam
Netherlands

Tel: 31 20 56 88 658
Fax: 31 20 56 88 677
Contact the contributor: m.dieleman@kit.nl

KIT Development, Policy and Practice, Royal Tropical Institute, Amsterdam, The Netherlands

Human Resource Management Research Group, Liverpool School of Tropical Medicine (LSTM), UK

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