Showing papers by "Eilish McAuliffe published in 2009"
TL;DR: It emerged that health workers were particularly dissatisfied with what they perceived as unfair access to continuous education and career advancement opportunities, as well as inadequate supervision, and a strong human resource management function operating at the district level is likely to improve worker motivation and performance.
Abstract: Background
Shortage of human resources is a major problem facing Malawi, where more than 50% of the population lives in rural areas. Most of the district health services are provided by clinical health officers specially trained to provide services that would normally be provided by fully qualified doctors or specialists. As this cadre and the cadre of enrolled nurses are the mainstay of the Malawian health service at the district level, it is important that they are supported and motivated to deliver a good standard of service to the population. This study explores how these cadres are managed and motivated and the impact this has on their performance.
165 citations
TL;DR: Although insufficient financial remuneration had a negative impact on retention and performance, the main factors identified were limited opportunities for career development and further education and inadequate or non-existent human resources management systems.
Abstract: Background
Malawi has a chronic shortage of human resources for health. This has a significant impact on maternal health, with mortality rates amongst the highest in the world. Mid-level cadres of health workers provide the bulk of emergency obstetric and neonatal care. In this context these cadres are defined as those who undertake roles and tasks that are more usually the province of internationally recognised cadres, such as doctors and nurses. While there have been several studies addressing retention factors for doctors and registered nurses, data and studies addressing the perceptions of these mid-level cadres on the factors that influence their performance and retention within health care systems are scarce.
114 citations
TL;DR: The Healthcare Provider Work Index identifies factors salient to improving job satisfaction and work performance among mid-level cadres in resource-poor settings.
Abstract: Much has been written in the past decade about the health workforce crisis that is crippling health service delivery in many middle-income and low-income countries. Countries having lost most of their highly qualified health care professionals to migration increasingly rely on mid-level providers as the mainstay for health services delivery. Mid-level providers are health workers who perform tasks conventionally associated with more highly trained and internationally mobile workers. Their training usually has lower entry requirements and is for shorter periods (usually two to four years). Our study aimed to explore a neglected but crucial aspect of human resources for health in Africa: the provision of a work environment that will promote motivation and performance of mid-level providers. This paper explores the work environment of mid-level providers in Malawi, and contributes to the validation of an instrument to measure the work environment of mid-level providers in low-income countries. Three districts were purposively sampled from each of the three geographical regions in Malawi. A total of 34 health facilities from the three districts were included in the study. All staff in each of the facilities were included in the sampling frame. A total of 153 staff members consented to be interviewed. Participants completed measures of perceptions of work environment, burnout and job satisfaction. The Healthcare Provider Work Index, derived through Principal Components Analysis and Rasch Analysis of our modification of an existing questionnaire, constituted four subscales, measuring: (1) levels of staffing and resources; (2) management support; (3) workplace relationships; and (4) control over practice. Multivariate analysis indicated that scores on the Work Index significantly predicted key variables concerning motivation and attrition such as emotional exhaustion, job satisfaction, satisfaction with the profession and plans to leave the current post within 12 months. Additionally, the findings show that mid-level medical staff (i.e. clinical officers and medical assistants) are significantly less satisfied than mid-level nurses (i.e. enrolled nurses) with their work environments, particularly their workplace relationships. They also experience significantly greater levels of dissatisfaction with their jobs and with their profession. The Healthcare Provider Work Index identifies factors salient to improving job satisfaction and work performance among mid-level cadres in resource-poor settings. The extent to which these results can be generalized beyond the current sample must be established. The poor motivational environment in which clinical officers and medical assistants work in comparison to that of nurses is of concern, as these staff members are increasingly being asked to take on leadership roles and greater levels of clinical responsibility. More research on mid-level providers is needed, as they are the mainstay of health service delivery in many low-income countries. This paper contributes to a methodology for exploring the work environment of mid-level providers in low-income countries and identifies several areas needing further research.
102 citations
TL;DR: The findings highlight the important role that managers can play in the motivation, career development and performance of mid-level health workers and their perceptions of how well they were treated by their managers and the extent to which they were informed about decisions and changes are highlighted.
71 citations
01 Jan 2009
TL;DR: Organisational learning theory can offer an new perspective on this process of accountability as mentioned in this paper, by viewing accountability as an organizational process, communication betweenaidpractitioners can become flexible or deutero learning.
Abstract: Developmentaidorganisationsarelearningnewmethodstodeliver effectiveaid.Organisationallearningtheorycanofferanew perspectiveonthisprocessofaccountability.Byviewingaccountability asarelationalprocess,communicationbetweenaidpractitionerscan becomeafieldofreflexiveor“deutero”learning.Thisisimportant foracomplexaidenvironmentinwhichthepoliciesofpartnership, harmonisationandalignmentrequirerelationalaswellastechnical skillssothatvitallinksacrossprogrammescanbemade.Irishaid organisationshaveanapthistory,policyandstyletomakea particularcontributiontowardslearningsuchreflexivepractices. Whilethedataforthispaperisprimarilyintra-organisational,such acategoryisincreasinglylooseinthechangingcontextofaid.Whatis soughtarepathstochangepracticeatdifferentlevelsoratany instanceofaidorganisationallife.