The Importance of Incentives

MALABIKA SARKER: Today, we’ll focus on why human resource is crucial for a successful program like polio eradication. Today’s this session topics include the importance of incentives, reaching special populations, gender roles, and the importance of politics, polio staff, and lethal violence. Everyone likes incentives, whatever the form is. So no wonder incentives also play a significant role for health workers, especially in low and middle-income countries, as salaried wages are often too low. The growing gap between the supply of health care professionals and the demand for their service is a critical issue facing governments, policymakers, program managers.

As we know from the course, there are a number of complex and interrelated factors that contribute to ongoing global shortage in the health workforce, including poorly resourced health systems, unsatisfactory working conditions, inadequate training and supervision. It is in this context that policymakers and program managers turn their attention to providing health workers incentive to improve recruitment, maintain motivation and morale, improve quality of service delivery, and increase retention of health care professionals. Numerous kinds of incentives exist, which are provided to health workers depending on the program policy task to be accomplished. Financial incentives are the most common type. However, alone they are often not sufficient to retain and motivate staff. Non-financial incentives play an equally crucial role.

They are particularly vital for countries and organizations while limited funding constraints the capacity to provide financial rewards. We can read from the testament shared by the health officials in India and Ethiopia that incentive is vital for health workers’ motivation. Broadly, incentives fulfill three goals towards the improvement of health service delivery– recruitment, retention, and motivation. Globally, health workers receive incentives in many different ways after the recruitment. In Ethiopia, upon completion of a 12-month training program, Health Extension Workers or HEW are assigned as salaried government employees to health posts and work directly with households. More than 42,000 government salaried female Health Extension workers have been deployed in the country, providing essential health services to households.

Similarly, in India, accredited social health activists– well known as ASHA workers– receive incentives for the work they carry out. In Bangladesh, however, BRAC– the largest NGO in the world– pioneered the use of female volunteer community health workers, known as Shasthya Shebika. Although they are volunteers, around 100,000 of Shasthya Shebika received performance-based financial incentive for their work. They also generate income from the profits they make from selling health commodities.

Retention is very important in the equitable distribution of health workers between urban and rural areas, hard to-reach areas, as well as being overworked and poorly paid, not paid on time, working in inconducive environments while resources and infrastructure are sorely lacking, lack of training, and working in insecure environments, resulting in high turnover, leading to acute human resource shortages. Financial incentives for improving health worker retention include loan repayment, rural retention grants, higher salaries for workers in unsafe areas, and provision of additional support such as accommodation, food, and transport. Motivation efficient at work is believed to be a key factor in the performance of individuals and organizations and is also a significant predictor of intention to quit the workplace.

Making workload reasonable, enabling workplace safe and secured, initiating performance-based rewards, and creating opportunities for career advancement are the few successful strategies for motivation. Let’s take a pause and try to answer the question about provision of per diem. The first question is, what might be likely adverse effects of providing such incentives? Question 2, how can public health programs better incentivize their human resources?