1. QUALITY IMPROVEMENT OF MATERNAL HEALTH SERVICES: HOW CAN MOTIVATION & RECOGNITION HELP ? RECONVENING BANGKOK: 2007 TO 2010 — PROGRESS MADE AND LESSONS LEARNED IN SCALING-UP FP/MNCH BEST PRACTICES IN THE ASIA AND MIDDLE EAST (AME) REGION MARCH 6-11, 2010 Dr. Nabeel Akram Regional Team Leader ANE, Jhpiego

2. The Challenge  Non or low performing health staff  Lack of interest  Work attrition  “Activities associated with appreciation such as performance management are currently not optimally implemented, as health workers perceive supervision as control, selection for training as unclear and unequal, and performance appraisal as not useful.” Dieleman M, et. al. Identifying factors for job motivation of rural health workers in North Viet Nam. Human Resources for Health 2003, 1:10 2

3. Motivation at Work  An individual's degree of willingness to exert and maintain an effort towards organizational goals Franco LM, Bennett S, Kanfer R: Health sector reform and public sector health worker motivation a conceptual framework. Social Science and Medicine 2002, 54:1255-1266  Motivation at work is believed to be a key factor in the performance of individuals and organisations and is also a significant predictor of intention to quit the workplace.”. Zurn P, Dolea L & Stilwell B (2005). ‘Nurse retention and recruitment: developing a motivated workforce’, ICN, Geneva 3

4. Motivation factors  Motivation to be in a job  working conditions, salary, relationship with colleagues, administrative supervision, etc.  Motivation to perform  achievement, recognition, responsibility and the work itself  In a study in Mali main motivators for health workers were found to be related to recognition or appreciation, responsibility and training Dieleman M, et. al. The match between motivation and performance management of health sector workers in Mali, Human Resources for Health 2006, 4:2 doi:10.1186/1478-4491-4-2 4

5. Some examples of Non Financial Incentives  Zambia: Refresher training (Mathauer and Imhoff, 2003)  Ethiopia: Mix of continuing education, housing provision and establishment of clear career structures (Mathauer and Imhoff, 2003)  Tanzania: Improved facility-related communications and transportation (DeSavigny, 2004)  Botswana, Namibia: Established set of benefits for nurses, including housing, car loans and medical allowance (Martineau, 2002)  Ghana: Proposal for more opportunities for two-year post- graduate training program (Dovlo and Nyontor, 1999)  Ghana, Namibia: Relaxing eligibility criteria for promotion (Huddart, 2003)  Swaziland, Malawi: Improved progression opportunities for all cadres (Dovlo and Martineau, 2004)  Ghana: Car and housing loan schemes for rural-based professionals (Dovlo and Martineau, 2004) 5

6. Motivating to Perform in Pakistan with Standards-based Management & Recognition 6

7. The Case of PRIDE Project, Pakistan  USAID funded project; led by International Rescue Committee; partners Jhpiego and MSH  Quality improvement of Primary Health Care services  Focus on MNCH/FP and developing EOC facilities  Standards-based Management & Recognition (SBMR)  126 Basic Health Units and Rural Health Centers  14 performance areas; 225 standards  2 districts in earthquake affected areas – Bagh and Mansehra 7

8. Standards-based Management & Recognition 8

9. Prominent Motivating Factors in PRIDE  Training and coaching  Group-based and on-the-job  Mentoring to change attitudes  Team approach: All facility staff training (not just providers)  Recognizing performance 9

10. Training & Coaching 10

11. Mentoring to Change Attitudes and Motivate Staff 11

12. Rewards & Recognition Ceremony  Sharing results and progress by district health office  Recognizing achievements of facility staff in improving quality of their MNCH/FP and other health services  Promoting healthy competition among facilities to provide better quality MNCH/FP services  Promoting team work  Recognizing high performing rural heath centers and basic health units; best practices shared to motivate staff at other facilities 12

13. BRONZESILVER Recognition categories Gold Awards for top performing facilities Silver Awards for facilities showing maximum improvement Bronze Award for special mention of key support staff Floating trophy for model facility Practical and team-building gifts GOLD Highest achievement Most improved Special mention 13

14. Achievement of infection prevention standards by facility – District Bagh 92% Birpani BHU Rangla BHU Rerah BHU 85% 14

15. Results: Quality of BEOC services improved Percent of service standards achieved in intervention facilities compared to non-intervention facilities, June 2009

16. Result: Quality of best practices improved Percent of quality standards for normal labor, complications and family planning achieved by service providers in 8 EOC facilities June 2007 to March 2009

17. Results: Increased institutional deliveries Average number of monthly deliveries in 8 EOC facilities tripled from January 2008 to December 2009 2008  2009  Full MNCH Program started in 8 facilities Service branding and marketing launched Quality improve- ment initiative started

18. Champions for Change  SBM-R process identifies “champions for change”  highly motivated  team leaders  experienced in self-assessment and action planning  master trainers  participate in assessments  organize exchange visits to their facility to share experiences and motivate 18

19. Thanks 19