Table 1 Research questions for health worker incentives survey, Ghana
Type of impact | Hypotheses about how the delivery fee exemption policy might affect HWs and TBAs | Indicators and expected direction of change |
|---|---|---|
Changes to income | 1. Main salary, allowances, per diems and benefits in kind not workload-related so should not change for public and mission staff. For private midwives, though, income is related to work, so will reflect demand for their services under the new policy. | Income from different sources collected to put other variable sources in perspective, but any change assumed to be unrelated to DFEP, except for private midwives. |
2. Private practice income might be reduced, if hours spent in public service increased, with increased demand. | Private practice hours, client numbers and income might decline, for public and mission HWs. | |
3. Incentive income related to the DFEP might redress any losses from other categories. | DFEP incentive payments monitored, for all groups other than TBAs. | |
4. Anecdotally, staff used to make pocket money from sales of items to women coming in for deliveries; this might be jeopardised by policy. | HWs asked about sales to patients. Reduction expected. | |
Changes to working hours and work load | 5. Would expect policy to increase working hours and workload for all HWs, public and private, and to diminish them for TBAs, who excluded from the policy*. | Working hours for main job, number of clients seen, and number of deliveries performed are all expected to rise, except for TBAs, where expect a drop (at least relative drop, allowing for population growth). |
Changes to general motivation | 6. Might expect working conditions to improve, if funding for scheme is sustained and drugs and supplies are easily acquired; or the reverse, if funding is inadequate. | Unclear direction, but indicators are answers to questions on HW views of the policy's impact (particularly in relation to drugs and supplies). |
7. Psychological benefits from knowing that all clients can access services and are not struggling to pay their bills. Staff no longer have to 'help' financially challenged women | HW views on the policy – expect positive reports on the overall impact of the scheme. | |
8. TBAs may be struggling and hostile to a policy which has negatively affected their business. Private midwives may also be disaffected if payments under the DFEP are less than they used to raise from user payments. | TBAs' and private midwives' views of the DFEP – expect negative reports from TBAs and ambivalent from private midwives. |