The challenges of developing an instrument to assess health provider motivation at primary care level in rural Burkina Faso, Ghana and Tanzania

Abstract

Background: The quality of health care depends on the competence and motivation of the health workers that provide it. In the West, several tools exist to measure worker motivation, and some have been applied to the health sector. However, none have been validated for use in sub-Saharan Africa. The complexity of such tools has also led to concerns about their application at primary care level.

Objective: To develop a common instrument to monitor any changes in maternal and neonatal health (MNH) care provider motivation resulting from the introduction of pilot interventions in rural, primary level facilities in Ghana, Burkina Faso, and Tanzania.

Design: Initially, a conceptual framework was developed. Based upon this, a literature review and preliminary qualitative research, an English-language instrument was developed and validated in an iterative process with experts from the three countries involved. The instrument was then piloted in Ghana. Reliability testing and exploratory factor analysis were used to produce a final, parsimonious version.

Results and discussion: This paper describes the actual process of developing the instrument. Consequently, the concepts and items that did not perform well psychometrically at pre-test are first presented and discussed. The final version of the instrument, which comprises 42 items for self-assessment and eight for peer-assessment, is then shown. This is followed by a presentation and discussion of the findings from first use of the instrument with MNH providers from 12 rural, primary level facilities in each of the three countries.

Conclusions: It is possible to undertake work of this nature at primary health care level, particularly if the instruments are kept as straightforward as possible and well introduced. However, their development requires very lengthy preparatory periods. The effort needed to adapt such instruments for use in different countries within the region of sub-Saharan Africa should not be underestimated.

• health personnel
• motivation
• performance
• maternal–neonatal health services
• developing countries

Acknowledgements

Untold gratitude is extended to the providers in Ghana, Tanzania, and Burkina Faso who agreed to invest their time and use the instrument.

To Maurice Yé and Ali Sié from Burkina Faso, to Siriel Massawe from Tanzania, and John Williams from Ghana and other colleagues from the partner institutions that partook in the validation of the instruments.

Whilst developing the pre-test version of the instrument in March/April 2011, the following experts kindly responded to a request for literature and documents: John Arudo, Marjolein Dielemann, Carmen Dolea, Delanyo Dovlo, Riitta-Liisa Kolehmainen-Aitken, Evelyn Kortum, Tim Martineau, Margaret Usher-Patel.

Thanks are extended to Valerie Louis for her help in preparing and translating the data-entry mask, to Vitus Atuah Atanga for his support with the analysis of the Ghana data and to Kirsten Külker for her assistance with the graphic and design work on the conceptual framework.