Motivation and retention of health workers in developing countries: a systematic review
Mischa Willis-Shattuck1, Posy Bidwell1, Steve Thomas*1, Laura Wyness2, Duane Blaauw3 and Prudence Ditlopo3
o 배경
¡ MDG 달성을 위해서 개발도상국의 보건의료시스템 강화가 필요하며, 핵심은 ‘동기부여된 의료인력’과 ‘그 의료인력의 유지’ 라고 할 수 있음.
¡ 아프리카에서는 HIV/AIDS 로 인해서 문제가 더 악화됨.
¡ 국제적 이주가 현재 문제의 핵심 원인 중 하나로 지적되고 있음.
¡ 간호사들은 전문직업적 발전, 더 나은 삶, 개인적 안위를 위하여 이주한다는 보고가 있으며, 아프리카에서만 $500M 이상의 돈이 궁극적으로 해외로 이민 의료인력의 양성(medical education)에 소모되고 있음.
¡ 부유한 국가에서는 가난한 국가를 타겟으로 한 인력 모집이 손쉬운 해결책이 됨.
¡ 이로 인해 가난한 국가들의 상황은 더 악화되어 남은 인력의 업무량이 증가하고 동기가 저하됨.
¡ 일부 국가에서는 외국에 나간 의료인력이 본국으로 송금할 돈을 위해서 의도적으로 의료인력을 수출하는 경우도 있음(Filipino nurses) 그러나 본국으로 송금한 돈이 의료에 사용된다는 보장도 없을뿐더러, 경험많은 인력이 빠져나감으로서 본국의 의료시스템이 발전하는데는 오히려 악영향을 줌.
¡ 의료인력의 이민 문제는 국외로 빠져나가는 것 뿐만 아니라 국내에서도 농촌에서 도시로, 공공 영역에서 사적 영역으로 빠져나가는 것이 문제가 됨.
¡ 개발도상국은 그들 자신의 의료시스템을 지키기 위한 전략을 세워야 함.
o 방법
¡ Systematic review methodology 사용
¡ Motivation의 정의 : 'an individual's degree of willingness to exert and maintain effort towards organizational goals’
o 결과
¡ 아프리카와 아시아를 대상으로 한 연구들이 포함되었음
- Africa : Benin, Cameroon, Ghana, Kenya, Malawi, Mali, Senegal, South Africa, Tanzania, Uganda, and Zimbabwe
- Asia : Bangladesh, Jordan, Georgia, Kazakhstan, Malaysia and Vietnam
¡ 동기부여와 관련된 일곱 개의 요인
- Financial (in terms of salary or allowances)
- Career development (in regards to the possibility to specialise or be promoted)
- Continuing education (having the opportunity to take classes and attend seminars)
- Hospital infrastructure (the physical condition of the health facility, in papers often described as 'work environment')
- Resource availability (refers to equipment and medical supplies that are necessary for health workers to perform their job)
- Hospital management (refers to having a positive working relationship with the management with whom the health workers work and with)
- Personal recognition or appreciation (either from managers, colleagues of the community)
¡ 그 외 : Other themes included fringe benefits (e.g. housing and transport allowances) [21,22], job security [23,24], personal safety [25], staff shortages [21,26] and social factors, such as effect on family life [21,22].
BMC Health Serv Res. 2008 Dec 4;8:247. doi: 10.1186/1472-6963-8-247.
Motivation and retention of health workers in developing countries: a systematic review.
Abstract
BACKGROUND:
A key constraint to achieving the MDGs is the absence of a properly trained and motivated workforce. Loss of clinical staff from low and middle-income countries is crippling already fragile health care systems. Health worker retention is critical for health system performance and a key problem is how best to motivate and retain health workers. The authors undertook a systematic review to consolidate existing evidence on the impact of financial and non-financial incentives on motivation and retention.
METHODS:
Four literature databases were searched together with Google Scholar and 'Human Resources for Health' on-line journal. Grey literature studies and informational papers were also captured. The inclusion criteria were: 1) article stated clear reasons for implementing specific motivations to improve health worker motivation and/or reduce medical migration, 2) the intervention recommended can be linked to motivation and 3) the study was conducted in a developing country and 4) the study used primary data.
RESULTS:
Twenty articles met the inclusion criteria. They consisted of a mixture of qualitative and quantitative studies. Seven major motivational themes were identified: financial rewards, career development, continuing education, hospital infrastructure, resource availability, hospital management and recognition/appreciation. There was some evidence to suggest that the use of initiatives to improve motivation had been effective in helping retention. There is less clear evidence on the differential response of different cadres.
CONCLUSION:
While motivational factors are undoubtedly country specific, financial incentives, career development and management issues are core factors. Nevertheless, financial incentives alone are not enough to motivate health workers. It is clear that recognition is highly influential in healthworker motivation and that adequate resources and appropriate infrastructure can improve morale significantly.
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