Association between health worker motivation and healthcare quality efforts in Ghana

Abstract
Background: Ghana is one of the sub-Saharan African countries making significant progress towards universal access
to quality healthcare. However, it remains a challenge to attain the 2015 targets for the health related Millennium
Development Goals (MDGs) partly due to health sector human resource challenges including low staff motivation.
Purpose: This paper addresses indicators of health worker motivation and assesses associations with quality care and
patient safety in Ghana. The aim is to identify interventions at the health worker level that contribute to quality
improvement in healthcare facilities.
Methods: The study is a baseline survey of health workers (n = 324) in 64 primary healthcare facilities in two regions in
Ghana. Data collection involved quality care assessment using the SafeCare Essentials tool, the National Health
Insurance Authority (NHIA) accreditation data and structured staff interviews on workplace motivating factors. The
Spearman correlation test was conducted to test the hypothesis that the level of health worker motivation is associated
with level of effort by primary healthcare facilities to improve quality care and patient safety.
Results: The quality care situation in health facilities was generally low, as determined by the SafeCare Essentials tool
and NHIA data. The majority of facilities assessed did not have documented evidence of processes for continuous
quality improvement and patient safety. Overall, staff motivation appeared low although workers in private facilities
perceived better working conditions than workers in public facilities (P <0.05). Significant positive associations were
found between staff satisfaction levels with working conditions and the clinic’s effort towards quality improvement and
patient safety (P <0.05).
Conclusion: As part of efforts towards attainment of the health related MDGs in Ghana, more comprehensive staff
motivation interventions should be integrated into quality improvement strategies especially in government-owned
healthcare facilities where working conditions are perceived to be the worst.