The scarce and ill-prepared health workforce has become one of the major global challenges in health care. Qualified health care workers are in short supply and demand is high. Because they work for low wages and in harsh conditions, these workers often become demoralized, and as a result, either leave their positions in search of something easier or more profitable or do less at work. Traditional approaches to motivating and retaining health workers, such as paying slightly higher salaries, have failed to close these motivational gaps. Around the world, health care delivery organizations have struggled to identify causes and implement solutions to sub-par performance, low motivation, and high turnover.

Recently, however, the concept of ‘engaging’ employees in the design, management, and results of their work offers a new way of thinking about managing employees. Extensive research conducted in the U.S. and other developed countries about service industries and client-facing roles has shown that if a person is “engaged” in his or her job, the productivity of the organization improves significantly, and he or she performs far better.  [Employee Engagement: The Key to Realizing Competitive Advantage. 2006. Wellins, Berhthal, Phelps, DDI, pg. 5.]

The USAID Health Care Improvement Project has adapted Gallup’s and other organizations’ employee engagement questionnaires to create a 26-item instrument that is appropriate to the environment of international public health in resource-poor countries. The questionnaire is explained and discussed in groups of similar types of health workers (literate, non-literate, administrative), and workers then complete the questionnaire individually and confidentially. Once the data are analyzed, teams of workers meet with supervisors to discuss scores and implement improvements at the local level. Engagement is measured again in three to four months, and results are compared and discussed. This improvement cycle enables health workers to focus on issues that affect them most.