Health workforce incentives and dis-incentives during the COVID-19 pandemic: experiences from Democratic Republic of Congo, Nigeria, Senegal, and Uganda.

Publication date: Apr 03, 2024

The COVID-19 pandemic presented a myriad of challenges for the health workforce around the world due to its escalating demand on service delivery. A motivated health workforce is critical to effectual emergency response and in some settings, incentivizing health workers motivates them and ensures continuity in the provision of health services. We describe health workforce experiences with incentives and dis-incentives during the COVID-19 response in the Democratic Republic of Congo (DRC), Senegal, Nigeria, and Uganda. This is a multi-country qualitative research study involving four African countries namely: DRC, Nigeria, Senegal, and Uganda which assessed the workplace incentives instituted in response to the COVID-19 pandemic. Key informant interviews (nā€‰=ā€‰60) were conducted with staff at ministries of health, policy makers and health workers. Interviews were virtual using the telephone or Zoom. They were audio recorded, transcribed verbatim, and analyzed thematically. Themes were identified and quotes were used to support findings. Health worker incentives included (i) financial rewards in the form of allowances and salary increments. These motivated health workers, sustaining the health system and the health workers’ efforts during the COVID-19 response across the four countries. (ii) Non-financial incentives related to COVID-19 management such as provision of medicines/supplies, on the job trainings, medical care for health workers, social welfare including meals, transportation and housing, recognition, health insurance, psychosocial support, and supervision. Improvised determination and distribution of both financial and non-financial incentives were common across the countries. Dis-incentives included the lack of personal protective equipment, lack of transportation to health facilities during lockdown, long working hours, harassment by security forces and perceived unfairness in access to and inadequacy of financial incentives. Although important for worker motivation, financial and non-financial incentives generated some dis-incentives because of the perceived unfairness in their provision. Financial and non-financial incentives deployed during health emergencies should preferably be pre-determined, equitably and transparently provided because when arbitrarily applied, these same financial and non-financial incentives can potentially become dis-incentives. Moreover, financial incentives are useful only as far as they are administered together with non-financial incentives such as supportive and well-resourced work environments. The potential negative impacts of interventions such as service delivery re-organization and lockdown within already weakened systems need to be anticipated and due precautions exercised to reduce dis-incentives during emergencies.

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Concepts Keywords
Democratic COVID-19
Hours Dis-incentives
Informant Health workforce
Medicines Incentives


Type Source Name
disease MESH COVID-19 pandemic
disease MESH emergency
disease IDO country
drug DRUGBANK Etoperidone
disease VO LACK
disease VO organization
pathway REACTOME Reproduction
disease MESH death
disease VO time
drug DRUGBANK Trestolone
drug DRUGBANK Vorinostat
drug DRUGBANK Ranitidine
disease VO population
disease VO vaccinated
drug DRUGBANK Water
disease IDO process
disease VO Tax
disease IDO contact tracing
drug DRUGBANK Aspartame
drug DRUGBANK Coenzyme M
drug DRUGBANK Polyethylene glycol
disease MESH infection
disease VO vaccination
drug DRUGBANK Serine
disease VO protocol
drug DRUGBANK Dimercaprol
drug DRUGBANK Methylergometrine
disease IDO facility
disease MESH panic
disease IDO intervention
drug DRUGBANK Ilex paraguariensis leaf
disease VO effective
disease VO Gap
disease MESH cross infection
disease MESH Infectious Diseases
disease VO manufacturing
disease MESH morbidity
disease MESH AIDs
drug DRUGBANK Spinosad
drug DRUGBANK Acetylsalicylic acid
disease MESH stunting
disease VO report
drug DRUGBANK Diethylstilbestrol
disease MESH ebola virus disease
drug DRUGBANK (S)-Des-Me-Ampa
disease MESH influenza

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