Health worker treating child with malaria (illustration) (photo: Ida Lindkvist)

Low health worker performance is a key obstacle to achieving the health-related Millennium Development Goals. While a lack of knowledge, equipment and medicine have been seen as the major challenges, a recent study pinpoints poorly motivated health workers as an important contributing factor to low quality health care in low-income settings.

One of the main findings is that many health workers are poorly motivated and invest a low level of effort per patient. The low level of effort results in brief history taking, superficial or no examinations, and few lab tests. Consequently, the diagnosis is likely to be insufficient, which can result in inadequate treatment.

Ida Lindkvist defends her dissertation “Health Worker Motivation and Effort in a Low-Income Context” on Friday 30th of September. Through discussions, observations and economic experiments, she and co-authors Ottar Mæstad, Aziza Mwisongo and Julie Riise Kolstad have explored  the concept health worker motivation in Tanzania, and studied how ownership and informal pay affect worker effort.

Tanzania hosts three types of health care providers; public, private not for profit and private for profit. In rural areas public and faith-based organizations (not for profit) are the main providers of health care. Lindkvist finds that although faith-based clinics are believed to provide better quality care, diagnostic effort is equally low in both faith-based and public clinics.  Health workers in faith-based clinics are however more polite and better at communicating findings to patients.

Informal payments constitute an important source of income for health workers in low-income countries. Nonetheless we know little about how such payments affect worker effort. Lindkvist found that informal payments do not result in higher average effort. However, health workers likely to accept payment display a greater variation in effort and are less sensitive to the medical condition of the patient.

Finally together with co-author Julie Riise Kolstad, Lindkvist explores a potential heterogeneity in the motivation of health workers across the public and private for profit sector. They find that students who prefer to work in the public health sector appear to have stronger pro-social preferences than students who prefer to work in the private-for-profit sector. Given the low levels of motivation among public sector workers, these findings suggest that it should be possible to improve worker motivation among public sector workers as they appear to come into the sector with an intrinsic motivation to help.

The findings suggest that policymakers should be aware that motivation matters for performance, and that low health worker motivation must be addressed if we are to achieve the health related millennium goals.


Trial lecture:
Friday 30th of September, 10.15 a.m. Topic: “Health Worker effort. Why it matters and what to do about it”. Venue: Auditoriet, Ulrikke Pihls Hus, Professor Keysers gate 1.

Friday 30th of September, 13.15 p.m. Venue: Auditoriet, Ulrikke Pihls Hus, Professor Keysers gate 1.