FRONTESPIZIO - Cooperazione Italiana allo Sviluppo

74 Carlo Resti, Yohannes TadesseVery Poor Motivation due to low level of remunerationEven though public sector salaries weighted against GDP for physicians inthe Ethiopian are said to be relatively higher when compared to other sub-Saharan African countries 7 , their actual magnitude is very low. In addition tothe very high salary gradient between the public and private/NGO sectors locally,salary levels are excessively low for physicians and nurses who have somedegree of access to the international labor market.In terms of salary gradient, it is interesting to note the huge and demoralizinggaps in payment scales between government hired workers and those secondedby other agencies who, otherwise, are assigned on exactly the same taskwith exactly the same qualification and experience. Such payment gaps wouldeven be incredibly large when a dimension of citizenship difference is addedbetween the personnel involved.Very Poor Motivation due to non-conducive working conditionsIn addition to low levels of remuneration, lack of conducive working conditionsare the major reasons given by health workers, especially physicians, forbeing reluctant to work in public, particularly rural health institutions. Theseconditions include: availability of basic equipment, drugs and supplies, accessto resources for updating oneself, fair opportunities for continuing educationand professional freedom. The other major complaint among those workingout of the major urban centers is lack of provisions for housing as well as scarcityof suitable educational facilities for children and close family members.Other types of poor working conditions that may lead to brain drain include:infrequently supervised facilities and limited career structure for personnel.Health Worker Morale and Professional EnvironmentA recent survey and experimental study to assess the development of intrinsicmotivation on a sample of newly graduating physicians and nurses inEthiopia has shown the majority of student physician and nurses as being intrinsicallymotivated 8 . One of the questions asked in this survey was designed7 The World Bank. Ethiopia A Country Status Report on Health and Poverty (DraftReport). March 2005. Draft Report No.28963-ET.8 Barr A, Lindelow M, Garcia-Montavio J and Serneels P. Intrinsic motivation on the developmentfrontline: Do they exist? Do they endure? 2005. Economic & Social ResearchCouncil (ESRC) Global Poverty Research Group.