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Table 1 Research questions for health worker incentives survey, Ghana

From: Working practices and incomes of health workers: evidence from an evaluation of a delivery fee exemption scheme in 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.
  1. * According to national guidelines, TBAs were not included. However, in one district in Volta, the district opted to include them in the DFEP, providing small payments per women delivered.