Association between health worker motivation and healthcare quality efforts in Ghana

Abstract

Background: Ghana is one of the sub-Saharan African countries making significant progress towards universal access to quality healthcare. However, it remains a challenge to attain the 2015 targets for the health related Millennium Development Goals (MDGs) partly due to health sector human resource challenges including low staff motivation.

Purpose: This paper addresses indicators of health worker motivation and assesses associations with quality care and patient safety in Ghana. The aim is to identify interventions at the health worker level that contribute to quality improvement in healthcare facilities.

Methods: The study is a baseline survey of health workers (n = 324) in 64 primary healthcare facilities in two regions in Ghana. Data collection involved quality care assessment using the SafeCare Essentials tool, the National Health Insurance Authority (NHIA) accreditation data and structured staff interviews on workplace motivating factors. The Spearman correlation test was conducted to test the hypothesis that the level of health worker motivation is associated with level of effort by primary healthcare facilities to improve quality care and patient safety.

Results: The quality care situation in health facilities was generally low, as determined by the SafeCare Essentials tool and NHIA data. The majority of facilities assessed did not have documented evidence of processes for continuous quality improvement and patient safety. Overall, staff motivation appeared low although workers in private facilities perceived better working conditions than workers in public facilities (P <0.05). Significant positive associations were found between staff satisfaction levels with working conditions and the clinic's effort towards quality improvement and patient safety (P <0.05).

Conclusion: As part of efforts towards attainment of the health related MDGs in Ghana, more comprehensive staff motivation interventions should be integrated into quality improvement strategies especially in government-owned healthcare facilities where working conditions are perceived to be the worst.

Figure 1

⁺⁺Mean percentage scores in five NHIA core standard areas (n = 64). ⁺⁺Mean percentage scores: calculated by adding all applicable criteria (0 – 3) scores under each standard area divided by the total expected score per standard area and multiplied by 100. Source: NHIA Accreditation data for 64 sampled health facilities (2009–2011). Legend: NHIA (National Health Insurance Authority).

Figure 2

⁺⁺⁺Mean percentage scores in essentials’ five patient risk areas (n = 64). +++Mean percentage scores: calculated by adding all applicable criteria (0 – 3) scores under each risk area divided by the total expected score per risk area and multiplied by 100. Source: COHEISION Project Patient Risk Assessment Using the Essentials Tool (March-June, 2012).