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Changing incentives for health workers in Uganda

Providing incentives to health workers in a rural setting can go a long way in boosting productivity and uptake of maternal health services.

This package may include refresher training, support supervision, supplies of requisite drugs and equipment, and financial incentives tagged to health facilities for use in an area of interest, according to latest analysis from the safe deliveries project in Uganda of the Future Health Systems (FHS) consortium.

TitledChanging incentives for health workers through a voucher scheme for maternal health services” by Dr Elizabeth Ekirapa-Kiracho, the FHS Uganda Team leader, the analysis was presented last month at the Irish Forum for Global Health which took place in Dublin, Ireland.

The outcomes of the project to modify incentives were impressive. The health workers’ behaviours changed for the better with increased allowances, top ups, increased income for facilities and improved working conditions.

“Like this money that we recently got I bought some scrubbing brush, liquid soap, Jik (detergent) and then moppers. I saw that it was encouraging the staff because we used to use hand brooms, compound brooms for scrubbing the ward. At least when you have this one it encourages the staff,” said a health worker.

Even clients noticed improvements emanating from the intervention.

“These days nurses attend to mothers even at night. […] Sometime ago [...] nurses would remain indoors without coming out to help the mothers,” noted a focus group discussion participant. Another added, “We had no love for a hospital because of the nurses; we used to change from hospital to hospital, but ever since the project came, we have love for our nurses.”

To arrive at these findings, a case study design was employed in the districts of Kamuli and Pallisa districts to generate data on constraints to good antenatal care and health facility delivery in a population of health workers, community leaders, and women of reproductive age.

The findings were particularly relevant to the Irish Forum for Global Health, whose aim is to contribute to improvement in the health of individuals and populations globally by creating networks that promote research and education and advocate for investment in global health.

The 2012 Dublin conference was on the theme of the Global Health Workforce, recognising that the critical shortage of skilled health personnel is one of the greatest global health challenges today. 

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