Abstract:
Background: The quality of health care depends on the competence and motivation of the health workers that
provide it. In the West, several tools exist to measure worker motivation, and some have been applied to the
health sector. However, none have been validated for use in sub-Saharan Africa. The complexity of such tools
has also led to concerns about their application at primary care level.
Objective: To develop a common instrument to monitor any changes in maternal and neonatal health (MNH)
care provider motivation resulting from the introduction of pilot interventions in rural, primary level facilities
in Ghana, Burkina Faso, and Tanzania.
Design: Initially, a conceptual framework was developed. Based upon this, a literature review and preliminary
qualitative research, an English-language instrument was developed and validated in an iterative process with
experts from the three countries involved. The instrument was then piloted in Ghana. Reliability testing and
exploratory factor analysis were used to produce a final, parsimonious version.
Results and discussion: This paper describes the actual process of developing the instrument. Consequently,
the concepts and items that did not perform well psychometrically at pre-test are first presented and
discussed. The final version of the instrument, which comprises 42 items for self-assessment and eight for
peer-assessment, is then shown. This is followed by a presentation and discussion of the findings from first use
of the instrument with MNH providers from 12 rural, primary level facilities in each of the three countries.
Conclusions: It is possible to undertake work of this nature at primary health care level, particularly if the
instruments are kept as straightforward as possible and well introduced. However, their development requires
very lengthy preparatory periods. The effort needed to adapt such instruments for use in different countries
within the region of sub-Saharan Africa should not be underestimated.
