# HEALTH WORKER SATISFACTION AND MOTIVATION

In all, 434 health workers were interviewed at baseline. Key characteristics are described in Table 13. The mean age of health workers was approximately 39 years and, on average, workers had been employed at the facility for between 4.4 (improved supervision) and 6.2 years (control; statistically different with p=0.05). Approximately two-thirds of health workers were female, and 75 percent had received either basic or level 2 secondary education. Just under half of workers were employed by the Ministry of health, with the remaining employed by religiously affiliated health facilities (19 percent), the facility (16 percent), or other employers (20 percent).

Health workers were read a series of statements relating to their wellbeing over the two weeks prior to the survey. These statements were taken from the World Health Organization’s (WHO) Well-being Index (Appendix Section WHO Being Index) and included, for example, “In the last two weeks, I have felt active and vigorous.” For each question, health workers were asked to indicate whether the statement described their state most of the time, more than half the time, less than half the time, only rarely, or never. For the purposes of analysis, these data were recoded into binary indicators. Responses were coded as “0” if the health worker replied half the time or less, and “1” otherwise. Thus, point estimates on the postXintervention arms indicate the percentage point increase or decrease in probability that a respondent in a given intervention group reported that a given statement was true at least half the time, relative to the pure control, after adjusting for individual-level indicators (age, sex, marital status, and education level) and facility-level indicators (type of health facility, urban/rural status).

Overall, the data do not provide strong evidence that PBF affected attributes included in the WHO’s wellbeing index (Table 14). Point estimates are generally small relative to standard errors, and there are no statistical differences between the pure control and the other intervention groups. However, the change in index score for three items – Active and energetic in the last 2 weeks, Refreshed and rested in the morning in the last 2 weeks, and Days filled with interesting things in the last 2 weeks was lower in the PBF group than the additional financing group.

<mark>Health workers were also asked a series of 26 questions related to their satisfaction with working conditions. These questions covered a range of topics, including relationships with individuals within and outside of the health facility, facility infrastructure and readiness to deliver services, salary and benefits, and their overall capacity to provide high-quality health services. For each question, a score of “1” indicates satisfaction, while a “0” indicates that a health worker reported either indifference or dissatisfaction.</mark> Point estimates, thus, indicate the percentage point increase or decrease in probability that a respondent in a given intervention group is satisfied with a particular issue, relative to the pure control, after adjusting for individual-level indicators (age, sex, marital status, and education level) and facility-level indicators (availability of electricity, availability of piped water, availability of latrine, facility open 24 hours, type of health facility, urban/rural status, and number of health workers employed at the facility).

<mark>There is little evidence of impact on working relationships (Table 15). The additional financing arm had the largest estimated impact on the relationship between the facility and District or Ministry of Health staff, but at 12.7 percentage points, this did not meet the 10-percent cutoff for significance. The PBF point estimate for an impact on the relationship with District or Ministry of Health staff is also positive and fairly large (β=0.103), but not statistically significant. The</mark> 21