Policy changes following health systems evaluation in Uganda

Ministries of Health in low-income countries have few policy tools at their disposal that are both affordable and rapidly effective at improving health systems with the purpose of raising population health status. Perhaps it's even more important than in wealthy countries that these Ministries make careful choices about how to spend scarce resources on policy measures. To that end, high quality operations research can be an important contribution to the policy selection process. Clever Ministries may even learn to aim donor and aid resources at collecting the kind of research that would aid them in wise policy formation.

The purpose of this APHA session is to provide examples of the kinds of policy-relevant research that can effectively support Ministries of Health. In Uganda, the Ministry requested the USAID-funded Capacity Project to survey health workers across the country in an effort to learn what leads to health worker satisfaction, motivation and retention. Low motivation among health workers is seen as the second most important health workforce problem in Africa (after staff shortages), a finding from a survey of ministries of health from 29 countries. Our Uganda survey uncovered a number of health worker views and attitudes that suggest policy solutions. For example: • Health workers uniformly are unsatisfied with their salaries. Our survey discovered, however, that health workers value other forms of compensation, as well. Getting health coverage for themselves and their families is a form of compensation health workers value even above salary, and is the kind of workplace benefit the Ministry could probably afford to add to its compensation packages. • Job satisfaction and intent to stay were significantly and independently correlated with the job being a good match for the workers skills and interests, an active sense of involvement in the facility, carrying a manageable workload, supportive supervision, flexibility to manage the demands of work and home, perceiving the job to be stimulating or fun, and job security. Some of these are issues that could be addressed without a large capital investment, with supervisor training, new family-friendly workplace policies, and personnel reforms.