Managing and Motivating: Pragmatic Solutions to the Brain Drain

Managing and Motivating: Pragmatic Solutions to the Brain Drain

Eilish McAuliffe (University of Dublin, Ireland), Ogenna Manafa (University of Dublin, Ireland), Cameron Bowie (College of Medicine, Malawi), Lucy Makoae (National University of Lesotho, Lesotho), Fresier Maseko (College of Medicine, Malawi), Mamello Moleli (National University of Lesotho, Lesotho & Ministry of Health and Social Welfare, Lesotho) and David Hevey (University of Dublin, Ireland)
DOI: 10.4018/978-1-4666-1601-1.ch054
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Abstract

It is now more than a decade since the acknowledgement of the health human resources crisis that exists in many low-income countries. During that decade much attention has focused on addressing the “pull” factors (e.g. developing voluntary international recruitment guidelines and bilateral agreements between recruiting and source countries) and on scaling up the supply of health professionals. Drawing on research conducted in two sub-Saharan African countries, we argue that a critical element in the human resources crisis is the poor working environments in these countries that not only continue to act as a strong “push” factor, but also impact on the motivation and performance of those who remain in their home countries. Unless attention is focused on improving work environments, the human resources crisis will continue in a vicious cycle leading to further decline in the health systems of low-income countries.
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Improving The Work Environment

Remuneration levels have been identified as potentially the most influential factor in a healthcare worker’s decision to migrate either between the public and private sector, or from low-income to higher-income countries (Dovlo, 2002). Efforts to address the workforce crisis include increased remuneration through salary top-ups, locum and rural allowances, and other forms of financial incentives. Such initiatives are based on the premise that the primary reason for migration is to obtain better remuneration. However, there is growing evidence that other factors in the work environment may also be acting as strong push factors. Workload and staff shortages are contributing to burnout, high absenteeism, stress, depression, low morale and de-motivation and are responsible for driving workers out of the public sector (Sanders & Lloyd, 2005). Poor working conditions are reported to seriously undermine health system performance by thwarting staff morale and motivation, and directly contributing to problems in recruitment and retention (Troy, Wyness & McAuliffe, 2007; WHO, 1996).

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