“If there is no motivation, the work stands still”: Lived experiences of local health managers innovating to retain health workers in the most deprived districts in Ghana

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Abstract Background Ghana is facing health workforce crisis, with mass exodus of experienced health workers out of the country, and challenges in retaining them in deprived areas. The local initiatives of health managers and community leaders in successfully retaining staff in deprived areas are less documented. Objective Using Maslow five-tier motivation model (physiological needs, safety, love and belonging, self-esteem, self-actualization), we describe how local management initiatives motivate and support health workers to stay in deprived areas. Method This study employed an exploratory qualitative approach. In-depth interviews were conducted with 21 district health managers and nine focus group discussions with community leaders between February and March 2024 as part of a larger project aimed at improving health workforce retention in the three most deprived districts in the Eastern region of Ghana. Interviews were audio-recorded and transcribed verbatim. The thematic framework approach, supported by QSR Nvivo 17 was used to analyse the data. Results Local managers innovated using existing resources, relationships and networks to engage, motivate and retain health workers in deprived communities in line with Maslow 5 tiers of motivation. They observed that meeting physiological needs, such as having decent living conditions and adequate compensation to meet their daily necessities, was a prerequisite for motivating and retaining staff. Community leaders played a critical role in safety needs through providing accommodation and security to safeguard the facility. To meet love and belonging needs in such isolated areas, they provided a unique community welcome for newly posted staff, set up peer support platforms, provided family support, and enhanced school facilities for staff with children. Local managers addressed self-esteem by prioritizing and lobbying for remote health workers who were due for promotion and study leave. Self-actualization was less visible, but it was reflected in a manager stating, “If there is no motivation, the work stands still.” Conclusion Without deliberate efforts to motivate staff, it is challenging for managers to attract and retain health staff willing to work in and stay in deprived communities. Existing human resource policies to motivate staff should provide guidelines that focus on ensuring these five tiers are met for the retention of staff in deprived communities.

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