Tutor motivation and retention in public health training institutions in Ghana: An exploration sequential mixed methods study

Abstract

Policymakers in the health sector continue to look for ways to improve the staffing of rural health facilities. However, only when they are equitably distributed and accessible by the population, when they possess the required competency, and are motivated and empowered to deliver quality care that is appropriate and acceptable to the sociocultural expectations of the society (WHO, 2016). Extensive research has been conducted on health worker motivation and retention in the clinical settings, but relatively little is known of the situation of staff in the Ministry of Health training institutions. Health-training institutions play a significant role in strengthening the health workforce of the country by training all the middle-level cadres of health professions like Nurses, midwives, and other affiliated health professionals (MoH, 2015). This thesis reports on a mixed-methods study of health tutors in some selected public health training schools in the northern part of the country, predominantly rural-based and some in the southern region, primarily urban-based. Focus group discussions engaged 100 health tutors from across rural and urban schools. Five in-depth interviews and five key informant interviews were conducted with past health tutors and principals, respectively. Focus group discussions and interviews informed the development of a structured questionnaire comprising closed and opened ended questions. The quantitative study used a representative sample of 329 health tutors. Non-parametric (Spearman ranked correlation, Pearson Chi-Square, and Wilcoxon-Mann Whitney) and parametric (t-test and ordered logistic regression) statistical tests were run. Findings suggest that most tutors actively compare their income, benefits, qualification to that of their colleagues in other schools, and with other general health workers in the clinical area and lecturers within the ministry of education. From the findings of the results, personal characteristics of the health tutors, such as his or her place of origin, rural or urban, gender, age, and family background, have a significant impact on their employment decisions. There was evidence from this research demonstrating that rural upbringing increases the chances of rural practice. While rural and urban health tutors equated motivation with money, those working in urban settings ranked accommodation as a significant factor influencing employment choice. In conclusion, the study examined differences in health tutors’ motivation and retention and some recommendations.