Zambian health workers motivated by dedication to profession, not financial gain

March 14, 2017 | Press Releases & Announcements

Dr. Gordon Shen

Dr. Gordon Shen, professor at CUNY Graduate School of Public Health and Health Policy, and colleagues recently published a study on the effects of performance-based financing on health workers in Zambia. The findings were published in the journal Human Resources for Health

Performance based financing (PBF) is a strategy that has been employed in a number of countries with the intention of transforming and improving health care, particularly maternal and child health. Dr. Shen’s study examined the effect of PBF on job satisfaction, motivation, and attrition of health workers in Zambia. The study evaluated before and after changes among three groups: the PBF (intervention) group, an enhanced financing (control 1) group, and a pure control (control 2) group.

The research team employed mixed methods. The quantitative portion comprised a baseline and an end line survey. The survey and sampling scheme were designed to allow for a rigorous impact evaluation of performance-based financing or enhanced financing on several key performance indicators. The qualitative portion sought to explain the pathways underlying the observed differences through interviews conducted at the beginning and at the three-year mark of the performance-based financing program.

Econometric analysis showed that both PBF and enhanced financing led to increased job satisfaction, but financial incentives had little effect on workers’ motivation. The health care workers continued to be motivated by their dedication to the profession and to providing health care to their community, rather than by financial incentives. While the PBF group showed decreased attrition among workers, the reasons for the lower turnover were attributed in part to health centers being staffed with quality personnel and those personnel having greater role clarity.

While financial incentives increased overall job satisfaction, it did little to change workers’ motivation. Dedication to helping others continues to be the driving force behind Zambian health workers’ motivation to show up for work every day.


Shen GC, Nguyen HTH, Das A, et al. Incentives to change: effects of performance-based financing on health workers in Zambia. Human Resources for Health. 2017;15(1). doi:10.1186/s12960-017-0179-2.