Public Sector Health Worker Motivation and Health Sector Reform: A Conceptual Framework

摘要

This paper offers a conceptual framework for considering the many layers of influences upon health worker motivation. It suggests that worker motivation is influenced not only by specific incentive schemes targeted at workers, but also by the whole range of health sector reforms which potentially affect organizational culture, reporting structures, channels of accountability, etc. In addition, the impact of such organizational reforms will be further mediated by the social and cultural context. By drawing attention to the broad range of influences, the paper aims to help policymakers develop and implement health sector reform policies that promote worker motivation and understand better the potential of specific incentives to induce higher worker motivation. Two themes run persistently throughout the paper: (1) the need to broaden understanding of motivational determinants beyond simply financial incentives to other, often less tangible, non-financial instruments (such as organizational culture and feedback from community); and (2) the need for methods to increase alignment of individual, organizational, and reform goals.