title: 'Your health our concern, our health whose concern?': perceptions of injustice in organizational relationships and processes and frontline health worker motivation in Ghana.
abstract: Taking a perspective of frontline health workers as internal clients within health systems, this study explored how perceived injustice in policy and organizational matters influence frontline health worker motivation and the consequent effect on workers' attitudes and performance in delivering maternal and neonatal health care in public hospitals. It consisted of an ethnographic study in two public hospitals in Southern Ghana. Participant observation, conversation and in-depth interviews were conducted over a 16-month period. Ethical approval and consent were obtained from relevant persons and authorities. Qualitative analysis software Nvivo 8 was used for coding and analysis of data. Main themes identified in the analysis form the basis for interpreting and reporting study findings. Findings showed that most workers perceived injustice in distributive, procedural and interactional dimensions at various levels in the health system. At the national policy level this included poor conditions of service. At the hospital level, it included perceived inequity in distribution of incentives, lack of protection and respect for workers. These influenced frontline worker motivation negatively and sometimes led to poor response to client needs. However, intrinsically motivated workers overcame these challenges and responded positively to clients' health care needs. It is important to recognize and conceptualize frontline workers in health systems as internal clients of the facilities and organizations within which they work. Their quality needs must be adequately met if they are to be highly motivated and supported to provide quality and responsive care to their clients. Meeting these quality needs of internal clients and creating a sense of fairness in governance arrangements between frontline workers, facilities and health system managers is crucial. Consequently, intervention measures such as creating more open door policies, involving frontline workers in decision making, recognizing their needs and challenges and working together to address them are critical.
authors.affiliation: Ghana Health Service, Navrongo Health Research Centre, P.O. Box 433, Bolgatanga, UER, Ghana, Sociology and Anthropology of Development Group, P.O. Box 8130, 6700 EW, Hollandseweg 1, Wageningen, The Netherlands, Graduate School of Social Sciences, Kloveniersburgwal 48 1012 CX Amsterdam, University of Amsterdam, The Netherlands, Noguchi Memorial Institute for Medical Research, NMIMR, University of Ghana, P.O. Box LG 581 Legon and School of Public Health, University of Ghana, P.O. Box LG 13 Legon Ghana Health Service, Navrongo Health Research Centre, P.O. Box 433, Bolgatanga, UER, Ghana, Sociology and Anthropology of Development Group, P.O. Box 8130, 6700 EW, Hollandseweg 1, Wageningen, The Netherlands, Graduate School of Social Sciences, Kloveniersburgwal 48 1012 CX Amsterdam, University of Amsterdam, The Netherlands, Noguchi Memorial Institute for Medical Research, NMIMR, University of Ghana, P.O. Box LG 581 Legon and School of Public Health, University of Ghana, P.O. Box LG 13 Legon Ghana Health Service, Navrongo Health Research Centre, P.O. Box 433, Bolgatanga, UER, Ghana, Sociology and Anthropology of Development Group, P.O. Box 8130, 6700 EW, Hollandseweg 1, Wageningen, The Netherlands, Graduate School of Social Sciences, Kloveniersburgwal 48 1012 CX Amsterdam, University of Amsterdam, The Netherlands, Noguchi Memorial Institute for Medical Research, NMIMR, University of Ghana, P.O. Box LG 581 Legon and School of Public Health, University of Ghana, P.O. Box LG 13 Legon matilda.aberese-ako@wur.nl maberese@gmail.com.
authors.forename: Matilda
authors.initials: M
authors.lastname: Aberese-Ako
authors.affiliation: Ghana Health Service, Navrongo Health Research Centre, P.O. Box 433, Bolgatanga, UER, Ghana, Sociology and Anthropology of Development Group, P.O. Box 8130, 6700 EW, Hollandseweg 1, Wageningen, The Netherlands, Graduate School of Social Sciences, Kloveniersburgwal 48 1012 CX Amsterdam, University of Amsterdam, The Netherlands, Noguchi Memorial Institute for Medical Research, NMIMR, University of Ghana, P.O. Box LG 581 Legon and School of Public Health, University of Ghana, P.O. Box LG 13 Legon.
authors.forename: Han
authors.initials: H
authors.lastname: van Dijk
authors.affiliation: Ghana Health Service, Navrongo Health Research Centre, P.O. Box 433, Bolgatanga, UER, Ghana, Sociology and Anthropology of Development Group, P.O. Box 8130, 6700 EW, Hollandseweg 1, Wageningen, The Netherlands, Graduate School of Social Sciences, Kloveniersburgwal 48 1012 CX Amsterdam, University of Amsterdam, The Netherlands, Noguchi Memorial Institute for Medical Research, NMIMR, University of Ghana, P.O. Box LG 581 Legon and School of Public Health, University of Ghana, P.O. Box LG 13 Legon.
authors.forename: Trudie
authors.initials: T
authors.lastname: Gerrits
authors.affiliation: Ghana Health Service, Navrongo Health Research Centre, P.O. Box 433, Bolgatanga, UER, Ghana, Sociology and Anthropology of Development Group, P.O. Box 8130, 6700 EW, Hollandseweg 1, Wageningen, The Netherlands, Graduate School of Social Sciences, Kloveniersburgwal 48 1012 CX Amsterdam, University of Amsterdam, The Netherlands, Noguchi Memorial Institute for Medical Research, NMIMR, University of Ghana, P.O. Box LG 581 Legon and School of Public Health, University of Ghana, P.O. Box LG 13 Legon.
authors.forename: Daniel Kojo
authors.initials: DK
authors.lastname: Arhinful
authors.affiliation: Ghana Health Service, Navrongo Health Research Centre, P.O. Box 433, Bolgatanga, UER, Ghana, Sociology and Anthropology of Development Group, P.O. Box 8130, 6700 EW, Hollandseweg 1, Wageningen, The Netherlands, Graduate School of Social Sciences, Kloveniersburgwal 48 1012 CX Amsterdam, University of Amsterdam, The Netherlands, Noguchi Memorial Institute for Medical Research, NMIMR, University of Ghana, P.O. Box LG 581 Legon and School of Public Health, University of Ghana, P.O. Box LG 13 Legon.
authors.forename: Irene Akua
authors.initials: IA
authors.lastname: Agyepong
mesh_terms: D000884:Anthropology, Cultural; D001291:Attitude of Health Personnel; D003659:Decision Making, Organizational; D005869:Ghana; D006282:Health Personnel; D006801:Humans; D007407:Interviews as Topic; D008875:Middle Aged; D009042:Motivation; D015279:Organizational Culture; D012935:Social Justice
keywords: Attitude; Ghana; frontline health workers; justice; motivation; people-centred health systems