ArticleBMJ global health2020
Which mechanisms explain motivation the of primary health workers? Insights from the realist evaluation of a maternal and child health programme in Nigeria.
Article in BMJ global health, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
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Who cites it
14 citing papers in PubMed, 29 citations in OpenAlex.
- Understanding motivating and demotivating factors among maternal healthcare professionals in Somalia: a qualitative interview study.BMJ global health · 2026Article
- Salary delays among public sector primary care workers: evidence from facility surveys across 16 low- and middle-income countries.BMJ global health · 2025Article
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- Mixed method evaluation of a learning from excellence programme for community health workers in Neno, Malawi.BMC health services research · 2024Article
- Participatory Health Cadre Model to Improve Exclusive Breastfeeding Coverage with King's Conceptual System.Journal of multidisciplinary healthcare · 2024Article
- Demand and supply analysis for maternal and child health services at the primary healthcare level in Nigeria.BMC health services research · 2023Article
- It is not all about salary: a discrete-choice experiment to determine community health workers' motivation for work in Nigeria.BMJ global health · 2022Article
- Acceptability and feasibility of community-based provision of urine pregnancy tests to support linkages to reproductive health services in Western Kenya: a qualitative analysis.BMC pregnancy and childbirth · 2022Article
- Village health worker motivation for better performance in a maternal and child health programme in Nigeria: A realist evaluation.Journal of health services research & policy · 2022Article
- 'You say you are a TB doctor, but actually, you do not have any power': health worker (de)motivation in the context of integrated, hospital-based tuberculosis care in eastern China.Human resources for health · 2022Article
- Public Service Motivation and Determining Factors to Attract and Retain Health Professionals in the Public Sector: A Systematic Review.Behavioral sciences (Basel, Switzerland) · 2022Review
- Role of trust in sustaining provision and uptake of maternal and child healthcare: Evidence from a national programme in Nigeria.Social science & medicine (1982) · 2022Article
- Evaluation of antenatal services at Family welfare Centre under RMNCH+A Programme in Delhi.Journal of family medicine and primary care · 2021Article
- Article
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Authors and funding
11 authors at 2 institutions in 3 countries.
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Abstract
introductionWell-trained, adequately skilled and motivated primary healthcare (PHC) workers are essential for attaining universal health coverage (UHC). While there is abundant literature on the drivers of workforce motivation, published knowledge on the mechanisms of motivation within different contexts is limited, particularly in resource-limited countries. This paper contributes to health workforce literature by reporting on how motivation works among PHC workers in a maternal and child health (MCH) programme in Nigeria.
methodsWe adopted a realist evaluation design combining document review with 56 in-depth interviews of PHC workers, facility managers and policy-makers to assess the impact of the MCH programme in Anambra State, Nigeria. A realist process of theory development, testing and consolidation was used to understand how and under what circumstances the MCH programme impacted on workers' motivation and which mechanisms explain how motivation works. We drew on Herzberg's two-factor and Adam's equity theories to unpack how context shapes worker motivation.
resultsA complex and dynamic interaction between the MCH programme and organisational and wider contexts triggered five mechanisms which explain PHC worker motivation: (1) feeling supported, (2) feeling comfortable with work environment, (3) feeling valued, (4) morale and confidence to perform tasks and (5) companionship. Some mechanisms were mutually reinforcing while others operated in parallel. Other conditions that enabled worker motivation were organisational values of fairness, recognition of workers' contributions and culture of task-sharing and teamwork.
conclusionsPolicy designs and management strategies for improving workforce performance, particularly in resource-constrained settings should create working environments that foster feelings of being valued and supported while enabling workers to apply their knowledge and skills to improve healthcare delivery and promote UHC. Future research can test the explanatory framework generated by this study and explore differences in motivational mechanisms among different cadres of PHC workers to inform cadre-related motivational interventions.
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