Unpacking the Drivers of Intrinsic Motivation for Health Workers in Malawi

Background: Increasingly, human resource management efforts recognize that the intrinsic motivation of health workers is associated with higher levels of retention and service delivery performance. However, there are few nationally representative studies that measure and determine the predictors of intrinsic motivation across the entire health system, including for public, private for-profit and faith-based health workers.

Methods: The USAID-funded Health Systems 20/20 project conducted a nationally representative study in Malawi that employed both qualitative and quantitative data collection methods to assess statistically significant drivers of intrinsic motivation. 602 health workers of every cadre and 612 randomly sampled clients were included in the study.

Results: Across sectors and cadres, health workers' overall level of satisfaction with absolute levels of compensation is not significantly associated with their overall level of intrinsic motivation. However, satisfaction with the fairness of compensation is a significant driver of motivation. The strongest drivers of motivation are not financial and include professional development opportunities, facility recognition, and opportunities for promotion. Contrary to anecdote, public sector workers demonstrated the highest levels of intrinsic motivation. Analyses indicate weak relationships between clients' overall satisfaction with their provider and health workers' perceptions about their jobs.

Conclusions: Non-financial incentives are sustainable and are statistically associated with increases in intrinsic motivation and job satisfaction for health workers. Motivation-based incentives may be more effective in promoting job satisfaction and retention than financial incentives. Client perceptions of care and satisfaction with services are associated with variables other than health worker motivation levels.