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What motivates you? Understanding what makes health care workers motivated to provide quality care for mothers and newborns in Ethiopia

by Matthew Quaife

published 14 June 2018

My part of the IDEAS phase II project is to assess how taking part in a quality improvement intervention affects the motivations of health workers. We want to understand how motivated they are, and what factors are particularly motivating or demotivating.

We are taking a mixed methods approach, conducting baseline and endline quantitative surveys supplemented by qualitative work halfway through the programme around drivers and levels of motivation. In April 2018, I travelled to Ethiopia to begin quantitative data collection among health care workers.


Unexpected visitors close to a health post in Ethiopia. Copyright: IDEAS/ Mattew Quaife

Along the way we encountered extreme weather as the rainy season hit in the south of the country, restrictions and limitations in electricity supply and mobile connectivity (important for sending data back to base), and the usual problems of vehicles breaking down. Alongside expectant mothers, we had some unexpected visitors to a health centre in Northern Tigray, whilst in the South we interviewed staff at a hospital on a plateau over 1000m higher than our accommodation.

Health workers are the crucial cogs in a health system, and making sure that staff are motivated and have the ability to do a good job is a priority for all health systems. A large portion of health system budgets are spent recruiting and training health workers, and where resources are scarce (such as in middle-income countries like Ethiopia), it is all the more important that systems retain workers to see a return on these investments.

The team at Addis Ababa University, School of Public Health, led by Abiy Seifu. Copyright: IDEAS/Matthew Quaife

Our implementation partner, the Institute of Health care Improvement (IHI), has worked closely with the Federal Ministry of Health to develop an amazing package of work, where health workers and management identify potential problems and implement solutions in learning collaboratives. With the ambitious aim of reducing maternal and neonatal facility-based mortality by a third in three years, the team have been piloting the programme over the last year: creating training programmes for external trainers and internal skill sharing, scaling up mentorship and other learning platforms, and addressing gaps in essential commodities.

Pausing for coffee in Tigray. Copyright: IDEAS/Matthew Quaife

Ethiopia’s expansive geography is beautiful, but challenging terrain makes it a difficult place to deliver any work at scale and IHI’s commitment to work across the breadth of Ethiopia’s four main regions made evaluating the impact of their work daunting.

Faced with the task of evaluating health worker motivation before IHI starts work, we randomly chose five local areas, Woreda, where collaboratives will take place later in 2018. Working with our evaluation partner Addis Ababa University we recruited eight exceptional research assistants who, over the course of four weeks, travelled far and wide to interview 400 health workers, doctors, and health system managers – 200 in areas where IHI will work, and 200 in areas where collaboratives will not take place, chosen due to their similarity on maternal and child health statistics. Powered by potent Ethiopian coffee, the team’s hard work saw us finish interviewing two weeks ahead of schedule. We will carry out some qualitative work as the collaboratives run this year, before returning with a quantitative survey in 2019. We expect to publish results in late-2019.





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Matthew Quaife

Assistant Professor