Rural-urban differences in health worker motivation and quality care in health facilities in Ghana

Close to 50% of the estimated 24 million Ghanaians live in rural areas but only 32.1% of the health sector workforce works in rural areas. Doctor patient ratio in a predominantly rural region is 1:18,257 compared to 1:4,099 in an urban region. These rural-urban inequities have contributed significantly to Ghana’s slow progress in achieving the millennium development goals 4,5 and 6. This study was conducted in 64 clinics among 324 staff in 16 rural and urban districts. Objective was to ascertain rural-urban differences in health staff motivation and the implications on quality care in health facilities. Results showed significant differences in quality care performance of rural and urban facilities in terms of “staff training in resuscitative techniques”, “orientation to job”, and “safe use of medications”. Staff in rural facilities were more de-motivate by poor water and electricity supply than those in urban facilities (p<0.05). Motivating staff along these identified gaps will help improve quality care and clients participation in the national health insurance scheme, which is experiencing enrolment and re-enrolment challenges because of poor service quality in accredited health facilities.