Factors Affecting Health Workers’ Motivation in a Fragile State: A Case Study of Juba Teaching Hospital, South Sudan.

Abstract

BAMIRIYO TOGYAYO ESPERANCE (2015-M121-10003) Factors Affecting Health Workers’ Motivation in a Fragile State: A Case Study of Juba Teaching Hospital, South Sudan. This study was conducted in Juba, the capital city of the Republic of South Sudan. Special consideration was to study the motivation of health workers in Juba Teaching Hospital (JTH) which is the only national referral hospital in the youngest African country which got its independence on July 11th 2011 after more than 20 years of civil war. Special consideration in this study was given to the situation of post-conflict of South Sudan within FCAS. The study was aiming at knowing the motivation of health workers in Juba teaching Hospital and determined factors that influence their motivation, especially in context of post-war and instability. The four specific objectives undertaken to achieve the results were; to assess the level of motivation of health workers, particularly medical doctors, clinical officers, nurses, midwives and laboratory staff; to determine factors that affects their motivation; to assess the extent of the influence of war and instability on their motivation; and to examine strategies put in place by respective authorities to support health workers overcome the challenges and effects of war on their motivation. This was a descriptive cross-sectional study which used a mixed method (both qualitative and quantitative) in order to determine the motivation of health workers in Juba teaching hospital. A total of 201 health workers in the hospital composed of medical doctors, clinical officers, nurses, midwives and laboratory staff were proportionally sampled and interviewed using self-administered questionnaires, focus group discussions, and key informant interviews. The statistical software IBM Statistical Package for the Social Sciences version 20, Microsoft Excel 2007 and Microsoft word document 2007 were used for raw data coding, entry and analysis. The results of the study showed that 66% of health workers at Juba Teaching Hospital were de-motivated. Reasons for their de-motivation being poor salary, poor working conditions, non-availability of policies and guidelines enacted, and slow decision-making process by respective authorities. Considering the level of motivation of each cadre, showed that medical doctors were more motivated than the rest of the cadres with 64.26%. It was also found out that 72% of all the respondents were happy with their profession although 54.23% would quit work in the hospital for reasons mentioned above if they get another employer within the medical field. This study revealed that health workers in JTH have a high patriotic spirit that maintains them faithful to their duties. In time of war and instability, community support, team spirit among staff motivated them to work. However, harassment, life threats and lack of transport to ensure their protection contributed to their de-motivation. The study revealed a positive Pearson correlation between working in war and instability on staff motivation with a significance of 0.713 two tailed. All the respondents were well versed about their profession and the motivation they derived from taking care of sick people. All were conscious and happy that their work in one way or another was contributing to the up building of their country after many years of conflict. During this post-war period, the existence of fragile socio-political and economic conditions in the country, poor salary, insecurity manifested through instability and harassment from patients and their relatives, poor working conditions, lack of clear policies and guidelines tempered with their motivation. A management more approachable and close to them would contribute to their strength all through but more especially in time of instability. The study recommends among others that the Ministry of Health– GoSS-RSS should do the following: increase and constantly sustain funding to the health sector; enact policies and guidelines responding to the situation of South Sudan and produce sufficient copies for use; provide training to empower the management of the hospital on managerial skills, especially various kinds of skills to motivate staff on the only national referral hospital. To the Hospital Management: communicate more efficiently to the staff, ensure a conducive working environment, offer timely salary to staff, ensure availability of equipment and supplies, and ascertain transport for staff especially during the time of instability. To health workers in JTH, keep up intrinsic motivators and the good team spirit. Key Words: Health Workers, Motivation, Fragile State, Hospital, South Sudan