Enhancing motivation of family planning service providers as a lever to avoid stock-outs and increase quality of service

Good progress is being made towards ensuring universal access to family planning (FP) services, mainly through strengthening the supply chains, tackling logistic and financial barriers, training of staff, broadening the choice of methods, and providing information and advocacy. However, sound supply-, counseling- and service provision systems, supported by good manuals and Standard Operating Procedures alone can’t guarantee that stock-outs are completely avoided and that quality of service is sufficient to ensure high user satisfaction of both the services provided and the methods used. If stock-outs were a purely technical issue, the problem would have been solved already. In order to boost progress, it is necessary and urgent to explore non-technical factors that may contribute to paving the way forward. A crucial -but seldom considered- building block in optimizing FP services is the human factor: the degree to which staff is motivated and feels responsible for delivering top quality and maximally meeting customer’s needs and expectations.

Staff motivation is however a key factor in ensuring sustainability of quality improvements. Poor motivation of health workers was also identified as an important problem by the Mozambican Ministry of Health. We want to explore how and to which extent the motivational factor of FP service and commodity provision can be optimized, and the impact this can have on avoiding stock-outs, improving service quality and customer satisfaction.

 

The project implements motivational actions as to evaluate the impact of motivation on good supply management (GSM) and quality of services. Following interventions will be implemented:

Intervention 2: Appraisal through outcome reports: again credits will be awarded to health centers conditional on GSM and FP services. Each month, the results of all health centers in the program, i.e. the credits earned, will be shared (anonymously) among the centers as to show health care providers the strengths and weaknesses of their center and to stimulate them to improve their work.

Intervention 3: Motivational training: one day of motivational training will be organized for the staff of the selected facilities.

 

The project is carried out by ICRH Mozambique in 15 health centers in Manhiça and Marracuene districts in Maputo Province, Mozambique. Three groups of each 5 health centers are randomly composed. Group 1 receives intervention 1 & 3, group 2 receives intervention 2 & 3, while group 3 is the control group and does not receive any of the interventions.

 

In 2014, data regarding supply management was gathered as to provide insights in current supply management. More particularly, copies of stock cards and patient files were collected. Ethical approval was requested in the beginning of 2015 and baseline data on motivation was gathered among providers by the end of May. In addition, intervention 1  and 2 were rolled out.

Currently, monthly visits to the health centers are carried out to register and evaluate their supply management while a motivational training is planned for October 2015 (i.e. intervention 3). The potential impact on motivation will be measured twice: a mid-term evaluation will take place in October 2015 while a final survey will be implemented in March 2016, when all interventions will be ended.