title: Frontline staff motivation levels and health care quality in rural and urban primary health facilities: a baseline study in the Greater Accra and Western regions of Ghana.
abstract: BACKGROUND
  The population of Ghana is increasingly becoming urbanized with about 70 % of the estimated 26.9 million people living in urban and peri-urban areas. Nonetheless, eight out of the ten regions in Ghana remain predominantly rural where only 32.1 % of the national health sector workforce works. Doctor-patient ratio in a predominantly rural region is about 1:18,257 compared to 1:4,099 in an urban region. These rural-urban inequities significantly account for the inability of Ghana to attain the health related Millennium Development Goals (MDGs) before the end of 2015.
  
  
  OBJECTIVE
  To ascertain whether or not rural-urban differences exist in health worker motivation levels and quality of health care in health facilities accredited by the National Health Insurance Authority in Ghana.
  
  
  METHODS
  This is a baseline quantitative study conducted in 2012 among 324 health workers in 64 accredited clinics located in 9 rural and 7 urban districts in Ghana. Ordered logistic regression was performed to determine the relationship between facility geographic location (rural/urban) and staff motivation levels, and quality health care standards.
  
  
  RESULTS
  Quality health care and patient safety standards were averagely low in the sampled health facilities. Even though health workers in rural facilities were more de-motivated by poor availability of resources and drugs than their counterparts in urban facilities (p < 0.05), quality of health care and patient safety standards were relatively better in rural facilities.
  
  
  CONCLUSIONS
  For Ghana to attain the newly formulated sustainable development goals on health, there is the need for health authorities to address the existing rural-urban imbalances in health worker motivation and quality health care standards in primary healthcare facilities. Future studies should compare staff motivation levels and quality standards in accredited and non-accredited health facilities since the current study was limited to health facilities accredited by the National Health Insurance Authority.
authors: Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, Netherlands. arkabason@gmail.com.|Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana. arkabason@gmail.com.
authors: Robert Kaba
authors: RK
authors: Alhassan
authors: Department of Economics, University of Ghana, Legon, Ghana.
authors: Edward
authors: E
authors: Nketiah-Amponsah
keywords: Ghana; Health facilities; Health worker motivation; Quality health care; Rural–urban