Trial reportPloS one2018
'We pledge to improve the health of our entire community': Improving health worker motivation and performance in Bihar, India through teamwork, recognition, and non-financial incentives.
Trial report in PloS one, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
23 citing papers in PubMed, 2 syntheses or guidelines pooled it, 49 citations in OpenAlex.
- Systematic review of performance-enhancing health worker supervision approaches in low- and middle-income countries.Human resources for health · 2022Pooled it
- Performance-based incentives and community health workers' outputs, a systematic review.Bulletin of the World Health Organization · 2021Pooled it
- Trial
- Understanding motivating and demotivating factors among maternal healthcare professionals in Somalia: a qualitative interview study.BMJ global health · 2026Article
- Enhancing the antenatal care quality through incentivized routine health information system in Northwestern Ethiopia: a quasi-experimental study (2020-2021).BMC public health · 2025Article
- Feasibility, acceptability, and effectiveness of a package of interventions to improve the performance of health workers in the Democratic Republic of Congo to deliver adolescent and youth sexual and reproductive health services.Global health action · 2025Article
- Negligence in data recording during institutional birth: exploring health workers' perspectives on the barriers and enablers of data documentation practices.Archives of public health = Archives belges de sante publique · 2025Article
- Incentives on the motivation and job performance; insights from community health workers in Iran.BMC health services research · 2025Article
- Developing a roadmap to reach and sustain 90% full immunization coverage through a cross-sectoral system strengthening strategy in Bihar, India.BMC health services research · 2024Article
- Effect of Performance-Based Nonfinancial Incentives on Data Quality in Individual Medical Records of Institutional Births: Quasi-Experimental Study.JMIR medical informatics · 2024Article
- Article
- Article
- Drivers of retention of the HIV workforce transitioned from PEPFAR support to the Uganda government payroll.Human resources for health · 2023Article
- Article
- Community health workers at the dawn of a new era: 8. Incentives and remuneration.Health research policy and systems · 2021Review
- The Impact of Community Generated PPE During the SARS-COV-2 Pandemic in Southeast Alabama and Gulfport Mississippi.Frontiers in health services · 2021Article
- Improving access to and use of contraception by adolescents: What progress has been made, what lessons have been learnt, and what are the implications for action?Best practice & research. Clinical obstetrics & gynaecology · 2020Review
- The community health worker as service extender, cultural broker and social change agent: a critical interpretive synthesis of roles, intent and accountability.BMJ global health · 2020Article
- Performance of revised national tuberculosis control program in Bihar: A situational analysis.Journal of family medicine and primary care · 2020Article
- Key challenges of health care workers in implementing the integrated management of childhood illnesses (IMCI) program: a scoping review.Global health action · 2020Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
13 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundMotivation is critical to health worker performance and work quality. In Bihar, India, frontline health workers provide essential health services for the state's poorest citizens. Yet, there is a shortfall of motivated and skilled providers and a lack of coordination between two cadres of frontline health workers and their supervisors. CARE India developed an approach aimed at improving health workers' performance by shifting work culture and strengthening teamwork and motivation. The intervention-"Team-Based Goals and Incentives"-supported health workers to work as teams towards collective goals and rewarded success with public recognition and non-financial incentives.
methodsThirty months after initiating the intervention, 885 health workers and 98 supervisors completed an interviewer-administered questionnaire in 38 intervention and 38 control health sub-centers in one district. The questionnaire included measures of social cohesion, teamwork attitudes, self-efficacy, job satisfaction, teamwork behaviors, equitable service delivery, taking initiative, and supervisory support. We conducted bivariate analyses to examine the impact of the intervention on these psychosocial and behavioral outcomes.
resultsResults show statistically significant differences across several measures between intervention and control frontline health workers, including improved teamwork (mean = 8.8 vs. 7.3), empowerment (8.5 vs. 7.4), job satisfaction (7.1 vs. 5.99) and equitable service delivery (6.7 vs. 4.99). While fewer significant differences were found for supervisors, they reported improved teamwork (8.4 vs. 5.3), and frontline health workers reported improved fulfillment of supervisory duties by their supervisors (8.9 vs. 7.6). Both frontline health workers and supervisors found public recognition and enhanced teamwork more motivating than the non-financial incentives.
conclusionsThe Team-Based Goals and Incentives model reinforces intrinsic motivation and supports improvements in the teamwork, motivation, and performance of health workers. It offers an approach to practitioners and governments for improving the work environment in a resource-constrained setting and where there are multiple cadres of health workers.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.