Human Resources for Health in Maternal, Neonatal and - HRH ...

Many of the incentives to health workers in MNRH at community level are focused on
increasing skilled birth attendance and family planning services. These range from rewarding
health workers for attending births or referring women to a facility of SBA, incentives to
increase SBA and Family planning service such as loans to midwives, deregulation or
compulsory community service for doctors. Financial incentives to health workers have been
found to increase access to services at community level but little is known if this has increase
equity of access. A systematic review of the impact of pay-for-performance on health
outcomes did not provide any strong evidence for the improvements in health outcomes
although it may provide improved access for community services (Petersen 2006). These
findings however do not address HRH in MNRH at community level in LMIC settings.
Schemes aimed at the provision of incentives to service providers to improve health such as
those outlined by Bitrán et. al (2003.) will also have a flow on to health workers. A case in
point is a performance based reimbursement scheme developed as part of a USAID funded
NGO Service Delivery Program involved in delivering primary health care services including
MNRH through an umbrella of NGOs in Bangladesh (Chao 2006). In order to encourage
NGOs and clinics to make significant efforts to serve the poor as well as to improve cost
recovery payments were made to service equity funds and bonuses were distributed according
to the services performance. The successful pilot of the scheme involved the payment of 25%
of bonuses received directly to high performing health workers (Chao 2006). Another
approach to performance based incentives is a programme in Zambia where high achieving
teams, rather than individuals were awarded non financial performance trophies. The success
of the pilot of this scheme on staff motivation differed in 2 sites according to the strong
leadership and performance management systems in place. This confirms the importance of
appropriate incentives alongside good HRM systems (Furth 2005). Kipp et als. study also
indicates that other factors may also be influential in the success of incentive schemes such as
an improved drug supply to health facilities and increased public identification with
community projects in remote areas (Kipp, Kamugisha et al. 2001). There is some evidence
to show that incentives such as loan repayments, direct incentives and medical residentsupport
programmes to encourage rural placement have highest service completion rates and
physician retention rates (Chopra 2008).
Relationships with the community including feedback from them on performance is regarded
as an important motivator in Vietnam (Dieleman, Cuong et al. 2003). In a community MNRH
context incentives that reward innovative partnerships and action between midwives and
women that involve the local community have been highlighted as critical in Cambodia
(Sherratt 2006). Community inputs into the selection of health workers may also motivate
workers to perform by establishing in them a sense that they are a representative of the
community and creating a feeling of responsibility to the community (IntraHealth 2008).
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