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Keywords: Motivation, Management Tool, Productivity, Health Workers.
OUTLINE
This
paper delves into the issue of motivation of Health Workers in Nigeria,
reviewed importance of motivation and how motivation can be a management tool
to increase workers’ productivity. Various opinions of the scholars were
collated and reviewed for objective assessment; thereafter the paper concluded
that motivation remains an important management tool and recommended the use of
motivation as a tool to secure job satisfaction and increase the health workers
productivity in Nigeria.
INTRODUCTION
There
have been efforts towards improving health system performance in Nigeria and
other developing countries by improving the availability and allocation of
resources, promoting more efficient management and rationalizing the role of
government. Various international communities have also shown concern and have
been contributing to its improvement overtime (WHO, 2017:7). However,
experiences, especially, in Nigeria health sector have shown that the positive
impact of such efforts and commitment anticipated has not been realized but
thwarted by the behavior patterns of health workers. Workers are central and
critical in the realization of effective and quality health delivery anywhere
in the world. Sara and Lynne (1999: 1) argue that “Effective and efficient health
care systems depend critically upon actions taken by individuals working in the
system”. And this services could best be realized only when the individuals
employed to deliver this service are willing and ready to do so. How does the
organization propel the workers psychological process, essentially in the
health sector, to realise the best performance and service delivery?
Worker
motivation is of critical importance in the health sector which is highly labor
intensive and quality service oriented. Therefore quality, efficiency and
effectiveness of healthcare service are directly related to and affected by
workers motivation. Factors such as technical know-how, resource availability
and good working environment are not sufficient enough to produce a desired
result, but it also includes intrinsic abilities of workers at work. Human
capacity is of paramount important in controlling other resources in production
for a desired result. Scholars have shown evidence that motivated workers come
to work more regularly, work more diligently, and are more flexible and willing
to work. They tend to become result-oriented workers. According to Hornby and
Sidney (1988), increased motivation creates the conditions for a more effective
workforce, but because work motivation is an interactive process between
workers and their work environment, good management system and supervision are
still critical factors in reaching organizational goals.Motivation is an
internal psychological process. It is not possible to motivate people directly
(at times through robust and prompt salary and wages payment), only to create
an environment conducive to high degrees of motivation.
While
accepting the fact that work motivation is an important part of ensuring a
desired goals of the organization, this paper offers an analytical, but
participatory discussion on how best to use motivation as a management’s tools
for increasing the productivity of health workers in Nigeria, having understood
that lack of motivation is one major important problem of health sector in the
country.
SITUATIONAL
ANALYSIS AND MOTIVATIONAL-RESOURCE FACTORS IN NIGERIA’S HEALTH INSTITUTION
In
the recent years, scholars and professionals have associated major factors
igniting the continual drain and incessant strike actions of health workers
associated with Nigeria health sector to motivational-resource issues
constantly absent in Nigeria’s health institutions. According to Eriki et al.
(2015:11), health workers in Nigeria are paid meagre salaries, often work in
insecure areas, and have heavy workloads, yet they lack the most basic
resources, including drugs and medical equipment and have little chance of
career development. Their reports stated further that doctors complain of
“brain waste”, and seek opportunities for professional development in countries
with better medical infrastructure. The rate of attrition from the health
sector in Nigeria is significant with an estimated annual loss of 2.4% of
Nigeria’s skilled health workforce. A newspaper reported in 2018 that an
average of 2000 medical personnel leave the shore of Nigeria yearly for better
opportunities abroad (The Guardian Newspaper, April 22, 2018).
The
data available point to European Region as a destination for Nigerian medical
and dental practitioners (African Centre for Global Health and Social
Transformation, 2015). All these are imminent among the factors advance by the
scholars of management to reduce rate of turnout and increase the performance
level in any organization. The character of the health institution that is
resulted into a continual brain drain is being caused by total lack of
motivation and thus affecting the productivity and loss of workforce. While few
ones have sought for greener pasture, better condition with good infrastructure
elsewhere, several others behind are constantly going on strike, to press for a
better welfare. Ladi Hamalai, Aremu Fatai and Aminu Umar in their 2015 reports
on Industrial Strike in the Health Sector: Incidences, Causes and solutions
claimed that between May 29 1999 and December 2014, there have been not less
than sixty (60) strike incidents in tertiary health system alone. According to
them, the frequency and intensity of strikes in various public health
facilities have risen sharply and this had ruptured the operations of hospitals
and completely blocks citizens’ access to healthcare usually for extended
period of time, and thus, caused thousands of preventable deaths. As a matter
of fact, Joint Health Sector Union (JOHESU) just suspended its more than a
month national indefinite strike in June, 2018 because of the welfare related
industrial issues (Figure 1).
Motivation
Motivation
whether intrinsic or extrinsic is generally perceived as conditions that boost
workers performance and directs their behavior towards accomplishment of
organizational goals. Motivation is regarded as the best strategy management
can deploy to stimulate the interest of employees to do their best, perform
most challenging jobs at acceptable level and to retain them in the
organization. Business dictionary defined motivation as internal and external
factors that stimulate desire and energy in people to be continually interested
and committed to a job, role or subject or to make an effort to attain a goal.
Motivation can also be described as the driving force which helps and causes us
to achieve goals, it is said to be intrinsic or extrinsic. From these
definitions we can see how important motivation is and how much influence it
has on the achievement of organizational goals. Scott (June, 2018) in his
article titled “Motivation and Productivity in the Workplace” said that most
employees need motivation to feel good about their jobs and perform optimally.
He observed that some employees are money motivated while others find
recognition and rewards personally motivating and that motivation levels within
the workplace have a direct impact on employee productivity. He concluded that
workers who are motivated and excited about their jobs carry out their
responsibilities to the best of their ability and production numbers increase
as a result.
Previous
Scholars had worked on motivation and how it affected and influenced the
productivity of workers at work; notable among these people was Maslow who
propounded motivation theory of needs in 1943, he identified 5 hierarchies
level of needs namely physiological/basic needs, safety needs, love and
belonging, self-esteem and self-actualization. Maslow’s theory is saying that
in order to get the most out of your team, you should also make sure you
support them in other aspects of their lives outside work. Perhaps you could
offer flexible working hours to give employees time to focus on their families
and make sure they are paid fairly to help them feel financially stable. In
their own opinions, Abah and Nwokwu (2016) said that Maslow’s theory clearly
shows that an individual’s motivation to work depends on the urgency of his
needs and the extent to which his needs are fulfilled through the organization
in which he works. Maslow’s ideas influenced many humanist and behavioural
scientists such as McClelland, Herzberg, Vroom and other renowned scholars. To
Herzberg, five factors are strong determinants of job satisfaction and
motivation which include: achievement, recognition, the attraction of the work
itself, responsibility and advancement.
Management Tools
Management
tools are strategies, system or control employed by the management to drive the
business of the organization so as to improve the performance. Wikipedia
online defined business management tools
as all the systems, applications, controls, calculating solutions, methodologies,
etc. used by organizations to be able to cope with changing markets, ensure a
competitive position in them and improve business performance. Bernard (2013)
observed that management tools, if they are used appropriately, can be powerful
enablers of change and actions in companies. He said they can, for example,
help define and execute the strategy, engage with customers and employees and
monitor performance. Motivation is seen as one of such tools that can be used
to monitor and increase workers’ productivity. This position was underscored by
Ian et al. (2015) when they said that motivation is an important tool that is
often under-utilized by managers in today's workplace. Managers use motivation
in the workplace to inspire people to work individually or in groups to produce
the best results for business in the most efficient and effective manner.
Motivation has been variously seen overtime as the most vital tool, yet
overlooked means of turning on the workers to give their best to attain
organizational goals as well as achieve job satisfaction at the workplace (Abah
& Nwokwu, 2016). Today, the focus of the management of any organization is
how to cope with current trends in business environment. Every organization has
a designed function to meet the Human Resources Management Trends strategic
objectives and maximize the performance of the employee. Therefore, it is
imperative that Human Resource Management is operating appropriately and in
accordance with the latest trends and technology to be able to deal with the
business life challenges. To be able to retain and sustain workers in complex
business environment driven by competition and technology, management need to
deploy motivation as one of the strategies as only motivated workforce will
stay to do their best.
Motivation and Productivity
Motivation
is crucial for good performance and therefore it is increasingly important to
know what motivates employees for better performance. Motivation as an innate
force that drives individual to continue doing his best has serious
relationship with productivity. Business Dictionary (2018) defined Productivity
as a measure of the efficiency of a person, machine, factory, system, etc., in
converting inputs into useful outputs. Productivity is computed by dividing
average output per period by the total costs incurred or resources (capital,
energy, material, personnel) consumed in that period. It is the effectiveness
of productive effort, especially in industry, as measured in terms of the rate
of output per unit of input. Productivity describes various measures of the
efficiency of production and it is a crucial factor in production performance
of firms and nations. There seems to be positive correlation between Motivation
and Productivity as agreed by most reseachers (Charles, 2008). That is to say,
when motivation increases, we should expect productivity to rise as a result.
This reflects the belief that an increased motivation level causes an increase
in productivity; it is a direct cause and effect relationship. He concluded and
said “I see motivation and productivity as being mutually causative. I regard
them as interactive. One impacts on the other, then the other impacts on it in
turn, or even simultaneously. They feed off each other.” Aderibigbe (2017)
agreed with this assertion when he concluded that there is a significant
positive relationship between employee motivation and productivity and
therefore, recommended that the personal needs of employees must be given a
consideration when applying motivation so that each employee will be able to
concentrate at work and consequently, give their best to the organizational
outputs. Similarly, Paul (2006) also concluded that although no relationship
was found between motivation and work rate but motivation has a significant
influence on the proportion of working time bricklayers spend productively.
Motivation and Health Workers
Productivity
The
relationships between proper human resource management in an organization and
positive employee attitudes have been widely analyzed (Sara & Lynne, 1999;
Silvestro, 2002). Several have posited that securing workers loyalty and
commitment is a function of underlining motivation factors ranges from
intrinsic to extrinsic (Friederike, 2009; Hornby & Sidney, 1988). They
brought out liberal self-igniting performance instrument that increases
productivity longer than expected. It is also suggested that treating employees
as a valuable asset improves their commitment and loyalty which leads to higher
performance and quality (Silvestro, 2002). Tomar and Shamar (2013) argued that
motivation is a kind of force which energizes people to achieve some common
goals. Every organization either public or private is goal oriented and all
efforts are geared towards the successful attainment of their goals and
objectives. Rothberg (2005) also concluded that that unless individual
employees are motivated to make efficient use of the potentials, the
organization may not achieve the level of performance that is desired from
them. The satisfaction of the employee represents an indispensable dimension of
the motivational process. A satisfied individual would certainly contribute
positively to the realization of organizational goals and objectives, while a
dissatisfied employee may not only contribute but can even act in such a way
that the realization of such goals and objectives could be completely
destroyed. This underlines the importance of employees’ satisfaction to the
organization (Anka, 1988).
Because of the above substantiated statements, managers often ask some fundamental questions: what can we do to motivate our workforce? Meanwhile, there is no single technique that answers this question. Aluko (2000) noted that the major motivational factor is monetary reward, good take home. Other factors includes frequent training and retraining, promotion, awards and recognition for a job well done, job security, upgrading and advancement, etc. go a long way to boost the morale of workers. It is true that the main reason behind running activities in an organization is to achieve organizational goals and organizational performance plays the major role in attaining such goals. Meeting personal goals help an employee stay motivated and give up their best; therefore achievement of organizational goal depends largely on workers motivation.
MOTIVATION AND WORKERS
PERFORMANCE: INTERROGATING THE MAJOR CAUSES OF DETERIORATING HEALTH SERVICES IN
NIGERIA
Nigeria
is facing a health crisis occasioned by a number of factors, essentially
welfare of the staff and infrastructural issues, which have affected the sector
over the past few decades. Both major causes bore down to the issues of
motivation. According to the former Nigeria Federal Minister of Health,
Professor Babatunde Osotimehin, while attempting to trace the causal pathway to
the rapidly declining performance of Nigeria’s health sector stated in the
forward of the National Strategic Health Development Plan Framework (2009-2015,
p. 2) that:
‘Currently, the health sector is
characterized by lack of effective stewardship role of government, fragmented
health service delivery, inadequate and inefficient financing, weak health
infrastructure, mal-distribution of health work force and poor coordination
amongst key players.’
Associated
with what the Minister highlighted above and other findings in literature,
there is monetary and non-monetary factor in the definition of motivation.
Monetary has to do with the increase and prompt payment of salary and
allowances of the workers while non-monetary include good working environment,
promotion and carrier advancement, education and training opportunities, awards
and honors, recognition devoid from nepotism, insurance, housing, etc. The
monetary and non-monetary have constituted into motivating menace affecting the
performance level of the staff and consequentially, quality health care
delivery in Nigeria. It has amounted into brain drain and strike actions.
The causes of
brain drain in Nigerian health institutions and incessant strike actions, why
health workers are leaving the shore of the country for other countries, what
is missing in Nigerian health sector and what is present in other countries
that serve as points of attractions were underscored and summarized in the
Table 1.
Looking
at the problem of motivation in Nigerian health care sector, Barbara et al.
(2004) agreed that health-care systems in developing countries are suffering
from years of underinvestment, and health workers were subjected to low wages,
poor working conditions, a lack of leadership and few incentives of any kind.
Korte et al. (2003) in their findings studying the motivation of health-care
workers in four developing countries in Africa have observed that low job
satisfaction and motivation affect the performance of health workers as well as
acting to push people to migrate. Their study has found that non-financial
incentives are important in motivating health care workers both to do a good
job and to continue working in public health services; these incentives include
training, study leave, the opportunity to work in a team and supports and
feedback from supervisors. In their report, some incentives were found to work
well to retain staff in rural areas. These included providing housing and
transport, agreeing the number of years that will be spent in a rural location
(rather than expecting a worker to remain there indefinitely), offering further
training and offering financial incentive. These findings and others support
previous work on motivation according to Stilwell (2001) and indicate that even
simple, relative low-cost measures may have positive effect on the motivation
of health workers and on retention.
Nevertheless,
the prospect of making substantially more money is thought to be pivotal factor
in the decision to migrate (Stalker, 2000; Xaba & Philips, 2001) and in
many source countries, introducing a competitive wage will be impossible.
Targeted incentives may be a more realistic possibility. In another way round,
moral teaching should be offered to various health workers and thus would
enhance their readiness and willingness to do thorough job in the rural areas.
For example, Barbara et al. (2004) posits that educating a group of
community-based health workers to offer health advice and simple treatments may
improve accessibility to health services, especially in rural areas and such
workers are far less likely to migrate internationally.
CONCLUSION AND RECOMMENDATION
Obviously,
Nigeria’s poor health status is attributable to the incessant strikes, brain
drain, and infrastructure decay in the healthcare system; all of which are
strong factors of motivation. While many of the workers have resulted to search
for better service condition beyond the shore of Nigeria, others are engaging
into strike actions. And this has been responsible for poor health care service
delivery, thus, preventable deaths are rampant and vulnerable, women and
children, are suffering from preventable diseases. Meanwhile, it is a common
knowledge that quality and effective health service delivery is a fundamental
right of the citizens. In fact, access to quality and affordable healthcare is
a basic human right and matter of constitutions.
Article
25 (1) of United Nations Universal Declaration of Human Rights provides that ‘everyone
has the right to a standard of living adequate for the health and well-being of himself and of
his family…including medical care and necessary social services.’ Chapter two
section 17 (3 c & d) of the Constitution of Federal Republic of Nigeria identifies
health as one of the fundamental objectives of state policy in which the state
is obliged to provide ‘adequate medical and health facilities for all persons.’
In consonance with international and national emphasis on health, the National
Health Act (2014) seeks to guarantee uninterrupted and effective functioning of
the healthcare system. Part V S. 5(1) classifies health as “Essential Service”.
In a forward
to The National Strategic Health Development Plan Framework (2009-2015), the
former Minister for Health, Professor Babatunde Osotimehin poignantly observed:
‘Health
is Wealth’ goes the popular saying and therefore in every country, the health
sector is critical to social and economic development with ample evidence
linking productivity to quality of health care. In Nigeria, the vision of
becoming one of the leading 20 economies of the world by the year 2020 is
closely tied to the development of its human capital through the health sector.
However, the health indicators in Nigeria have remained below country targets
and internationally-set benchmarks including the MDGs, which have recorded very
slow progress over the years.
Meanwhile,
successive government has been finding a lasting solution to the poor service
delivery in the health sector. There were Committees set up by the Federal
Government. “Presidential Committee in 2011 headed by Justice Abdullahi Bello
Gusau and that of 2013 headed by former Secretary to the Government of the
Federation Yayale Ahmed. The Yayale Ahmed Committee streamlined the issue into
nine (9) broad issue areas. These are: organizational management issues;
leadership and teamwork issues; remuneration parity/relativity and motivational
issues; career and management issues; capacity building issues; professional
practice issues; labour issues; legal issues and governance/policy issues.
However, virtually all nine broad issues highlighted by Yayale Ahmed are
elements of motivational factors and reasons behind the brain drain and
incessant strike actions in the health sector. This shows that motivation
remains the only tool available to stabilize and increase the productivity of
the workers in Nigeria health sector.
Therefore, one
may advance an argument that motivation is critical to retaining the workers
and to ignite their readiness to perform optimally in Nigeria health sector.
For increasing the productivity of health workers, it is recommended that
government and managements of health institutions in Nigeria should focus more
on motivation issues such as remuneration, good working environment, training
and retraining of workers, infrastructure development, career progression,
recognition and award based on meritocracy, and many more others. From this
review therefore we can conclude that motivation remains the only management
tool available to retain and sustain health workers as well as increase the
productivity of the workers in Nigeria health sector.
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