Rural-urban differences in health worker motivation and quality care in health facilities in Ghana.

Abstract

Background: The population of Ghana is increasingly becoming urbanized with 50.9% of the estimated 24 million people currently living in urban areas compared to 43.8% in the year 2000. Nonetheless, eight out of the ten regions in Ghana remain predominantly rural where only 32.1% of the national health sector workforce works. Doctor-patient ratio in a predominantly rural region is 1:18,257 compared to 1:4,099 in an urban region. These rural-urban inequities significantly contribute to Ghana’s slow progress in achieving the millennium development goals 4, 5 and 6. Purpose: To ascertain rural-urban differences in health worker motivation and the implications on quality care in health facilities. Methods: This is a baseline semi-quantitative study conducted among 324 health workers in 64 accredited clinics in 16 rural and urban districts in Ghana. Multivariate multiple regression was conducted to ascertain the relationship between facility geographical location (rural/urban) and staff motivation levels and quality care standards. Results: Quality care and patient safety standards were generally low but relatively better in rural facilities especially in primary healthcare services. Health workers in rural facilities were more de-motivated by extrinsic factors such as poor water and electricity supply and payment of financial incentives (p<0.05). The major source of de-motivation for urban workers was lack of transportation to work (p<0.05). Conclusion: For Ghana to attain, the MDGs 4, 5 and 6, there is the need to address existing rural-urban imbalances in health worker motivation and quality care standards in primary healthcare services. Future researchers should compare motivation levels and quality standards in accredited and non-accredited health facilities since the current study was limited to only NHIS accredited facilities.