Table 1 Summary of articles under review

Agyepong et al. 2004 [67]

Ghana

Description of factors that influence HW job satisfaction and motivation

HWs across public health facilities in the Greater Accra region

Continuous quality improvement, structured questionnaires

Statistical/Pareto analysis

Workplace obstacles such as salaries and lack of equipment, tools and supplies influence HW motivation.

Alhassan et al. 2013 [56]

Ghana

To explore the quality of care and patient safety situation in health facilities accredited by the Ghanaian National Health Insurance Authority and identify associations with HW motivation

Clinical and non-clinical HWs

Structured questionnaires based on in-depth interviews

Statistical analysis with STATA version 12

Low motivational levels. HWs dissatisfied mainly with non-financial incentives including transport to work, career development prospects and poor relations due to resource inadequacy at the workplace. Membership in professional associations had a positive influence on their professional practice.

Campbell et al. 2011 [72]

Zimbabwe

To examine nurses’ motivation and frustration in the context of the roll-out of antiretroviral treatment in Zimbabwe

Nurses, HIV counsellors, nurse-pharmacist, nurse assistant and administration clerks

In-depth interviews, focus group discussions (FGDs) and ethnographic observation

Thematic analysis

HWs’ motivation to provide high-quality antiretroviral treatment influenced by patients’ emotional improvement and recoveries, patient commitment to treatment and personal experiences for compassion. HWs demotivated by staff shortages, inadequate medicines and equipment, low salaries and losing patients’ confidence.

Chandler et al. 2009 [58]

Tanzania

To evaluate factors that affect motivation and levels of motivation among non-physician clinicians

Non-physician clinicians

Interviews and FGDs, quantitative survey instrument

Thematic analysis and statistical analysis

Salary ranked as the most important source of motivation. Non-financial factors that influence motivation include social status expectations, working environment and relationships with different cadres.

Dickin et al. 2011 [53]

USA

To identify important sources of motivation to facilitate the development of strategies to enhance community HW motivation and enhance performance and program effectiveness

Community nutrition educators

Qualitative in-depth interviews, quantitative surveys and supervisor questionnaire

Coding using the constant comparative approach and thematic analysis using ATLAS.ti software

Community nutrition educators mentioned several factors as motivators, including interest in educating people on food and nutrition, caring relationships developed among participants and the educators, freedom to make job-related decisions, relationships with supervisors and the team, and good health benefits

Dieleman et al. 2003 [50]

North Viet Nam

Perceptions on what motivates and demotivates HWs, perceptions of HWs and managers on HRM tools, perceptions of community members

Policy makers and managers; HWs (ass. doctor, nurses, midwives); community members

Semi-structured exit interviews, FGDs

Qualitative data analysis

Financial and non-financial incentives influence motivation, especially appreciation by managers, colleagues and community, stable job, income and training

Dieleman et al. 2006 [62]

Mali

To describe HW motivation and demotivation factors and match motivators with implementation of performance management

Managers, HWs, village committee members

In-depth interviews and FGDs, cross-sectional descriptive survey (questionnaire)

Statistical analysis (SPSS). Triangulation of qualitative data and survey

Salary, responsibility, training, recognition and rewards. Performance management like job descriptions, supervisions, continuous education and performance appraisal influences motivation

Franco et al. 2004 [51]

Jordan and Georgia

Identify motivational determinants in LMICs’ public health sector. Identify interventions and strategies for health care reforms to facilitate HW motivation

Two public hospitals in each country. Key informants at hospital and Ministry of Health managers, supervisors, HWs and patients

Contextual analysis (qualitative interviews and document reviews). 360-degree assessment (qualitative and quantitative, structured interviews). In-depth analysis

Statistical analysis using psychometric scales

Financial and non-financial determinants at individual, socio-cultural and organisational levels.

Greenspan et al. 2013 [61]

Tanzania

To explore sources of community HWs’ motivation to inform programmes in Tanzania and similar contexts

Community HWs

Semi-structured in-depth interviews

Thematic analysis

Levels of motivation identified as individual, family, community and organisational. Families and communities providing moral and financial support, recognition and encouragement. At the organisational level, monetary support, job security, tools and supplies for work, training and supervision considered as motivational factors.

Hegney et al. 2006 [52]

Australia

To identify intrinsic and extrinsic work values that influence job satisfaction

Public, private and aged care nurses

Survey questionnaire

Statistical analysis (SPSS). Thematic analysis of qualitative data from the questionnaire

Remuneration, rewards, working conditions, work stress, autonomy and social relations at work affect job satisfaction and intention to leave employment.

Kahler et al. 2012 [47]

Denmark

To explore motives for choosing employment at either public or private hospitals in a group of Danish surgeons. To examine effects of organisational characteristics on motivation

Surgeons

Qualitative interviews

Phenomenological/thematic analysis

Motivational factors that were identified include possibility to provide optimal patient care, having influence on the job, challenging work tasks, relationships with colleagues and ideological reasons.

Kok and Muula 2013 [69]

Malawi

To identify factors that influence motivation and job satisfaction of health surveillance assistants in Malawi, in order to inform development of strategies to influence staff motivation for better performance

Health surveillance assistants

Key informant interviews, FGDs and a group discussion with supervisors. Questionnaire for household survey of surrounding community

Coding framework for qualitative data analysis. Statistical analysis using SPSS version 17 for quantitative data analysis

The study found that salaries were low with no opportunity for promotion and that there were heavy workload with no job descriptions and lack of opportunities for training. The workers were further demotivated by lack of transport, lack of recognition from supervisors and management, limited supervision and lack of communication.

Kontodimopoulos et al. 2009 [43]

Greece

To identify motivational factors of health professionals and to determine if the factors differ in the public and private sectors

Doctors, nurses and office workers in 13 hospitals

Quantitative: 28-item questionnaire survey

Statistical analysis (SPSS)

Both monetary and non-monetary factors determine HW motivation. Achievement, remuneration, working relationships with co-workers and job attributes influence HW motivation. Health professionals in private hospitals were motivated more than those in public hospitals.

Kudo et al. 2010 [44]

Japan

To examine associations between work motivation and job satisfaction among Japanese nurses to improve their motivation

Nurses

Self-administered questionnaires

Statistical analysis

Nurses do feel motivated not only by money but also by their work as specialists, workplace safety, relationships with superiors, work–life balance, relationships among themselves and communications with physicians.

Kyaddondo and Whyte 2003 [63]

Uganda

To study the effect of decentralisation and policy reforms on HW motivation

4 health units, health managers, health unit management committee and health unit workers

Interviews, document reviews, FGDs and observation

Qualitative data analysis

Decentralisation is critical to professional autonomy, recognition, coping strategies and demotivation

Lambrou et al. 2010 [45]

Cyprus

To investigate how medical and nursing staff of Nicosia General Hospital is affected by specific motivation factors, and the association between motivation and job satisfaction. To determine the motivational drive of socio-demographic and job-related factors in terms of improving work performance

Doctors, dentists and nurses

Cross-sectional survey (questionnaire)

Statistical analysis

Achievements were ranked as the top main motivator followed by remuneration, co-workers and job attributes. Female HWs were more motivated by remuneration compared to male HWs. Professional relationships with colleagues and supervisors was identified as a source of satisfaction and motivation.

Leshabari et al. 2008 [70]

Tanzania

To measure the extent to which HWs at Muhimbili National Hospital were satisfied with their work. To identify factors associated with low motivation in the workplace

Doctors, nurses, auxiliary clinical workers, and administrative and support staff.

Structured interviews (cross-sectional study)

Statistical analysis (SPSS)

HW dissatisfaction and low motivational levels due to low salaries, lack of equipment and drugs, inadequate performance evaluation and feedback, poor communication channels in different units (and between workers and management), lack of participation in decision making, lack of concern for HWs’ welfare by management.

Malik et al. 2010 [60]

Pakistan

To identify the determinants of job motivation among physicians

Physicians from public primary, public secondary and public and private tertiary health facilities

Open-ended questions, semi-structured self-administered questionnaires and in-depth one-on-one interviews

Thematic analysis and statistical analysis

Motivating factors mainly intrinsic and socio-cultural, including serving people, respect, career growth and personal safety. Demotivators included few opportunities for higher qualifications, resource unavailability, poor supervision and poor interpersonal relations.

Manafa et al. 2009 [64]

Malawi

To explore how clinical health officers are managed and motivated and the impact this has on their performance

District managers, Ministry of Health officials and different cadres of HWs

FGDs, key informant interviews

Thematic analysis

Continuous education, career progression, supervision and feedback on performance considered inadequate by HWs, while performance appraisals and clear job descriptions were non-existent. District managers did not perceive these factors as having an impact on motivation.

Manongi et al. 2006 [66]

Tanzania

To explore the experiences of HWs working in the primary health care (PHC) facilities in Kilimanjaro Region. To identify areas for sustainable improvement to services provided by HWs

Multiple cadres of HWs in PHC facilities in 3 districts, district medical officers

2 FGDs in each of the 3 districts, semi-structured interviews

Thematic analysis

Staff shortages, poor supervision from managers, lack of transparency in career development opportunities.

Mathauer and Imhoff 2006 [57]

Benin and Kenya

To assess the role of non-financial incentives for motivation

Doctors and nurses in rural areas, Ministry of Health officials

Semi-structured qualitative interviews, FGDs

Statistical (SPSS) analysis of quantitative and coded qualitative data

Appreciation of professionalism, recognition, career development, supervision, participation in decision making, performance appraisals and team-based performance management influence motivation.

Mbilinyi et al. 2011 [71]

Tanzania

To explore the challenges generated by HIV care and treatment and their impact on HW motivation in Mbeya Region

Different cadres of HWs

Qualitative in-depth interviews

Qualitative framework analysis and thematic analysis

Demotivation due to risk of contracting HIV and tuberculosis; lack of acknowledgement and appreciation from managers and community; staff, drugs and essential supplies shortages; poor infrastructure; favouritism; and relationships between HWs and colleagues and with the community.

Mbindyo et al. 2009 [59]

Kenya

To explore contextual influences on HW motivation

HWs and key informants in 8 rural district hospitals

Individual in-depth interviews, small group interviews, FGDs and observation

Thematic analysis using NVivo 7 software

Management practices at the hospital level influences HW motivation. Supportive leadership fosters good working relationships and improves motivation through incentives, promotions, performance appraisals and good communication processes. Poor schemes of service demotivate.

Mubyazi et al. 2012 [65]

Tanzania

To describe the supply-related drivers of motivation and performance of HWs in administering preventive treatment of malaria at ante-natal clinic services in public and private facilities

Clinical officers, nursing officers, midwives, laboratory personnel, nurse auxiliaries, public health nurses, maternal and child health aides, and health assistants

Field observations, document reviews, in-depth interviews and questionnaire with a mix of closed- and open-ended questions

Content analysis of qualitative data and statistical analysis of quantitative data (STATA 8.2)

Dissatisfaction and performance constraint due to poor working environment, understaffing, poor supervision, limited career development opportunities and poor health facility infrastructure and staff houses. HWs in private facilities more motivated compared to those in the public facilities.

Newton et al. 2009 [74]

Australia

To identify what motivates individuals to engage in nursing career

Registered nurses and nurse managers

Semi-structured interviews, surveys and fieldwork observation

Thematic analysis

Desire to help, a caring motive, sense of achievement and self-validation were identified as factors that influence nurses’ motivation.

Peters et al. 2010 [46]

India

To identify important aspects of HW satisfaction and motivation in 2 Indian states in both public and private sectors

Doctors, nurses and other HWs

Cross-sectional questionnaire survey using a 17-item instrument

Statistical analysis

Non-financial motivators identified include good working relationships with co-workers, workplace environment and opportunities for personal development, recognition and autonomy. Good financial remuneration also considered as an important motivator.

Prytherch et al. 2012 [55]

Tanzania

To explore HWs’ understanding of motivation. To explore factors that encourage or discourage providers of maternal and newborn health care in rural areas. To explore factors that influence rural HWs’ performance and job satisfaction

Maternal and newborn HWs in rural settings

In-depth interviews

Thematic analysis using NVivo v9 software

HWs had understandings of motivation. Identified motivators or source of satisfaction included community appreciation, perceived government and development partner support and on-the-job learning. Discouragements were related to poor security, health and safety, lack of job descriptions, problematic supervision and performance appraisal.

Prytherch et al. 2013 [49]

Burkina Faso, Ghana and Tanzania

Maternal and neonatal health care providers, policy-level informants, district- and facility-level managers

In-depth interviews

Thematic analysis

Most community HWs mentioned that they were drawn to the profession for altruistic reasons. Other than salaries and incentives, good relationships with managers, supervisors, patients and the community also influenced motivation. Problems in rural areas like availability and cost of water and electricity, difficult working conditions, distance to one’s family and lack of information demoralised the HWs.

Razee et al. 2012 [48]

Papua New Guinea

To investigate social factors that lead to motivation of staff working in and affect performance of lower level health facilities in rural PNG

Health extension officers, community HWs and nursing officers

Face-to-face semi-structured in-depth interviews

Thematic analysis (NVivo 8.0 software)

Good relationships with staff, community and friends, and cooperation and responsibility from the patients were mentioned as motivators. HWs were unhappy with poor communication and interpersonal relations, lack of trust and respect, societal expectations around women, workplace safety and security.

Siril et al. 2011 [54]

Tanzania

Assessing individual and site-related factors associated with HW-reported stress, motivation and perceived ability to meet the needs of patients enrolled in PEPFAR-supported public sector HIV clinics. To identify areas for improvement to promote staff retention of HWs in resource-limited settings.

HWs at HIV care and treatment centres

Self-administered questionnaire

Statistical analysis in SAS 9.1.

Half of the respondents felt motivated to perform their jobs. Motivation was influenced by specialised training, adequate supervision, ability to meet patient needs, teamwork with good understanding, respect and good communication among staff members, good working environment and availability of equipment and supplies. Lack of feedback on performance demotivated HWs.

Zinnen et al. 2012 [68]

Tanzania

To contribute to empirical evidences on human resources for health motivation by assessing the role of financial and non-financial incentives and measuring the reasons to stay working in rural areas

Different cadres of HWs and district/council health management team

In-depth interviews with key informants, structured questionnaires with closed- and open-ended questions, and document and report review

Coding and analysis using MAXQDA software version 2007. Epi Info software version 3.5.3 for quantitative data analysis

High staff stability in public health facilities. HWs motivated by better job security, salary and retirement benefits, supportive supervision and support for career development. Dissatisfaction was due to inadequate work equipment, staff shortages, heavy workload and favouritism in allocations for allowances and further training.