According to The State of the World’s Midwifery 2014 Report, there is only an estimated 27% met need of the workforce (midwives and physicians) available to provide midwifery services in Uganda. How do we address the unmet need? Incentives!
“What are the incentives? Think about the incentives.” These are phrases I have heard so often in regards to motivating midwives and reducing the rate of attrition. When we talk incentives, many times we are referring to financial incentives. Financial incentives have proved successful but the biggest challenge with this has been sustainability of such reward systems.
Incentives are classified as financial or non-financial. However, according to the World Health Report 2000, incentives for health workers are “all the rewards and punishments that health workers receive as a result of the organization in which they work, the institution under which they operate and the specific interventions they provide” (WHO 2000). As we look to double the number of the workforce available to provide midwifery services by 2030 there is need to design incentives that are specifically targeted to:
• Encourage health workers provide midwifery services
• Support staff recruitment and retention
• Enhance productivity and quality of services
Whether financial or non-financial it is important to recognize that health workers will respond differently to these incentives depending on the level at which they are in their career.
On a recent visit to Isingiro in South-Western Uganda, I met with Godwin, an enrolled comprehensive nurse who had just started working the previous year at Rushasha Health Centre III, which is approximately two hours away from Isingiro town. An enrolled comprehensive nurse is a nurse able to provide midwifery services. In the absence of the midwife in charge, Godwin is providing antenatal care to expectant mothers. A queue awaits him outside as it is a Tuesday- a day dedicated to antenatal services. Godwin expressed his happiness at being able to step in for the midwife and offer these services. He said it gave him the opportunity to practice his skills and the more he did it, the less likely he was to forget. When asked what motivates him to keep doing this, he remarked that when mothers go away happy and bring in other mothers he is happy because it shows he is doing a good job. He was also encouraged by the support supervision and in-service trainings he had received through Jhpiego’s intervention.
For Godwin and others like himself, who are at the beginning of their career, the motivation sparked by financial incentives is not as important as non financial incentives like support supervision, continuous learning that can guarantee growth and progression in their career.
The ideal scenario would be that by 2030, the number of midwifery graduates and physicians would have doubled from the current 29% to 48% (The State of the World’s Midwifery Report 2014). If we are to achieve this goal, I think it is necessary to rethink incentives and how we award these. Let us not only look at the financial incentives but also consider the merits and appeals of non-financial incentives.