title: The challenges of developing an instrument to assess health provider motivation at primary care level in rural Burkina Faso, Ghana and Tanzania.
abstract: The quality of health care depends on the competence and motivation of the health workers that provide it. In the West, several tools exist to measure worker motivation, and some have been applied to the health sector. However, none have been validated for use in sub-Saharan Africa. The complexity of such tools has also led to concerns about their application at primary care level.
  
  
  
  To develop a common instrument to monitor any changes in maternal and neonatal health (MNH) care provider motivation resulting from the introduction of pilot interventions in rural, primary level facilities in Ghana, Burkina Faso, and Tanzania.
  
  
  
  Initially, a conceptual framework was developed. Based upon this, a literature review and preliminary qualitative research, an English-language instrument was developed and validated in an iterative process with experts from the three countries involved. The instrument was then piloted in Ghana. Reliability testing and exploratory factor analysis were used to produce a final, parsimonious version.
  
  
  
  This paper describes the actual process of developing the instrument. Consequently, the concepts and items that did not perform well psychometrically at pre-test are first presented and discussed. The final version of the instrument, which comprises 42 items for self-assessment and eight for peer-assessment, is then shown. This is followed by a presentation and discussion of the findings from first use of the instrument with MNH providers from 12 rural, primary level facilities in each of the three countries.
  
  
  
  It is possible to undertake work of this nature at primary health care level, particularly if the instruments are kept as straightforward as possible and well introduced. However, their development requires very lengthy preparatory periods. The effort needed to adapt such instruments for use in different countries within the region of sub-Saharan Africa should not be underestimated.
authors.affiliation: Institute of Public Health, University of Heidelberg, Heidelberg, Germany. helen.prytherch@yahoo.com
authors.forename: Helen
authors.initials: H
authors.lastname: Prytherch
authors.forename: Melkidezek T
authors.initials: MT
authors.lastname: Leshabari
authors.forename: Christiane
authors.initials: C
authors.lastname: Wiskow
authors.forename: Gifty A
authors.initials: GA
authors.lastname: Aninanya
authors.forename: Deodatus C V
authors.initials: DC
authors.lastname: Kakoko
authors.forename: Moubassira
authors.initials: M
authors.lastname: Kagoné
authors.forename: Juliane
authors.initials: J
authors.lastname: Burghardt
authors.forename: Gisela
authors.initials: G
authors.lastname: Kynast-Wolf
authors.forename: Michael
authors.initials: M
authors.lastname: Marx
authors.forename: Rainer
authors.initials: R
authors.lastname: Sauerborn
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002050:Burkina Faso; D002055:Burnout, Professional; D005260:Female; D005869:Ghana; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008427:Maternal Health Services / Q000592:standards* / Q000639:trends; D008875:Middle Aged; D009042:Motivation; D009359:Neonatology / Q000592:standards* / Q000639:trends; D011204:Poverty Areas; D011320:Primary Health Care / Q000592:standards* / Q000639:trends; D011594:Psychometrics / Q000295:instrumentation*; D036301:Qualitative Research; D011787:Quality of Health Care / Q000592:standards*; D019035:Rural Health Services; D013636:Tanzania; D000078329:Workforce; D055815:Young Adult