‘Your health our concern our health whose concern?’:perceptions of injustice in organizational relationships and processes andfrontline health worker motivation in Ghana

摘要

Taking a perspective of frontline health workers as internal clients within health systems, this study explored how perceived injustice in policy and organizational matters influence frontline health worker motivation and the consequent effect on workers’ attitudes and performance in delivering maternal and neonatal health care in public hospitals. It consisted of an ethnographic study in two public hospitals in Southern Ghana. Participant observation, conversation and in-depth interviews were conducted over a 16-month period. Ethical approval and consent were obtained from relevant persons and authorities. Qualitative analysis software Nvivo 8 was used for coding and analysis of data. Main themes identified in the analysis form the basis for interpreting and reporting study findings. Findings showed that most workers perceived injustice in distributive, procedural and interactional dimensions at various levels in the health system. At the national policy level this included poor conditions of service. At the hospital level, it included perceived inequity in distribution of incentives, lack of protection and respect for workers. These influenced frontline worker motivation negatively and sometimes led to poor response to client needs. However, intrinsically motivated workersovercame these challenges and responded positively to clients’ health careneeds. It is important to recognize and conceptualize frontline workers inhealth systems as internal clients of the facilities and organizations withinwhich they work. Their quality needs must be adequately met if they are to behighly motivated and supported to provide quality and responsive care to theirclients. Meeting these quality needs of internal clients and creating a sense offairness in governance arrangements between frontline workers, facilities andhealth system managers is crucial. Consequently, intervention measures such ascreating more open door policies, involving frontline workers in decisionmaking, recognizing their needs and challenges and working together to addressthem are critical.