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5. Human resources for health (HRH): a crucial element for achieving international MDGs. 75Very Poor Motivation due to non-conducive working conditionsIn addition to low levels of remuneration, lack of conducive working conditions are the major reasonsto given assess by health why workers, the students especially had physicians, chosen forto being pursue reluctant a career to work in public, the health particularly sector. ruralhealth institutions. These conditions include: availability of basic equipment, drugs and supplies, accessThe to resources frequencies for updating with oneself, which fairthey opportunities gave the for continuing five most education common and professional answer, freedom. someother The other answer, majoror complaint reported among no those special working reason out offor the their major urban career centers choice is lack are ofpresent-ed Other in Figure types of 2. poor As working shown conditions in the that figure, may lead desire to brain to help drain people, include: infrequently an indication supervised ofprovisionsfor housing as well as scarcity of suitable educational facilities for children and close family members.intrinsic facilities and motivation, limited careerwas structure a response for personnel. given by over 64% of the sample.Health Worker Morale and Professional EnvironmentA recent survey and experimental Figure 2 study - Reasons to assess for the Choosing development Professionintrinsic motivation on a sampleof newly graduating physicians and nurses (Barr inA Ethiopia et al., has 2005) shown the majority of student physician andnurses as being intrinsically motivated 8 . One of the questions asked in this survey was designed toassess why the students had chosen to pursue a career in the health sector. The frequencies with whichthey gave the five most common answer, some other answer, or reported no special reason for theircareer choice are presented in Figure 2. As shown in the figure, desire to help people, an indication ofintrinsic motivation, was a response given by over 64% of the sample.Figure 2 - Reasons for Choosing Profession(Barr A et al., 2005)100This particular study has also shown evidence that intrinsic motivations are50socially rather than individually determined and, therefore, may change asthe social contexts 0 of the individuals change and may be eroded by exposureto an environment To help in which peopleunproductive Tobehavior get job is endemic. This impliesthat even though For most goodphysicians payment and nurses Assigned graduate by government with high degree of intrinsicmotivation,Traditionintegrityof myand familycommitmentOther reasonto “serve people”, such altruisticbehaviors require good working conditions as well as conducive profes-No Special reasonsional environment to endure.This particular study has also shown evidence that intrinsic motivations are socially rather thanIn addition to good working conditions, social and professional environmentsmay beare eroded important by exposure in to sustaining an environment health in which workers’ unproductive intrinsic behavior motivation, is endemic. a fact Thisindividually determined and, therefore, may change as the social contexts of the individuals change andimplies that even though most physicians and nurses graduate with high degree of intrinsic motivation,that integrity signals and commitment the importance to “serve people”, of professionalizing such altruistic behaviors the require health good sector working environment.as wellOn as conducive the other professional hand, environment unless such to endure. intrinsic motivations are sustained andconditionsIn addition to good working conditions, social and professional environments are important inthe sustaining problems health in workers’ personnel intrinsicmanagement motivation, a fact are thatproperly signals the addressed, importance of they professionalizing can endangeradaptive and counterproductive behaviors.the health sector environment. On the other hand, unless such intrinsic motivations are sustained andthe problems in personnel management are properly addressed, they can endanger adaptive andA counterproductive World Bank behaviors. assessment of health worker performance in Ethiopia, basedA World Bank assessment of health worker performance in Ethiopia, based on data from focus groupondiscussions,data fromhas attemptedfocus groupto outlinediscussions,both the naturehasofattemptedperformance problems,to outlineas wellbothas thethepossiblenatureof performance problems, as well as the possible structural reasons forthese 8 Barr A, Lindelow M, Garcia-Montavio J and Serneels P. Intrinsic motivation on the developmentproblems as they relate to human resource policies 9 frontline: Do theyexist? Do they endure? 2005. Economic & Social Research Council (ESRC) Global Poverty. Research Among Group. the per-9 Lindelow M, Semeels P and Lemma T. The Performance of Health Workers in Ethiopia:Results from Qualitative Research. World Bank Policy Research Working Paper 3558,April 2005.