Table 3.

Qualitative Studies.

Author(s), Year of Publication	Country	Main Objective	Sample Size	Main Research Findings
Banek et al., (2015) [40]	Republic of Uganda	To understand the level of support available, and the capacity and motivation of community health workers to deliver these expanded services, we interviewed community medicine distributors (CMDs), who had been involved in the home-based management of fever (HBMF) programme in Tororo district, shortly before integrated community case management (ICCM) was adopted.	n = 100	The determinants of motivation involved an opportunity to be altruistic, gaining social status and recognition, creating future opportunities for employment and health-related knowledge gain.
				Demotivation sources were the community or government having unrealistic expectations, limited drugs and essential supplies such as gloves, poor supervision, and lack of compensation and respect as a result.
Daniels et al., (2013) [18]	Republic of Kenya	To present two distinct motivations for a clinical research career that informed women’s decision-making to pursue international training and describe two common steps in the pathway toward a clinical research career for women in Kenya.	n = 12	Two main determinants of motivation among the women medical doctors were professionally related motivators and attainment of family–career balance through engaging in clinical research. Demotivating determinants of the doctors included limited institutional capacity, low morale in the workplace and limited intellectual engagement.
Greenspan et al., (2013) [41]	United Republic of Tanzania	This study aimed to explore sources of community health workers motivation to inform programmes in Tanzania and similar contexts.	n = 20	Individual sources of motivation by CHWs comprised intrinsic desire to volunteer and support community, dedication to public service, desire for knowledge to help self and family and desire to educate the community.
				Organizational sources of motivation were monetary support, hope for future employment (job security), training tools for work and supervision.
				Family sources of motivation were moral, material and monetary support
				Community sources of motivation included recognition and encouragement through positive reception and acquiring fame in the community.
Kaye et al., (2010) [21]	Republic of Uganda	To assess the influence of this training experience on students’ willingness, readiness and competence to work in rural health facilities by surveying 60 recent graduates of Makerere University Faculty of Medicine, who completed their studies during the transition from traditional to problem-based learning (PBL) curriculum.	n = 60	Motivating determinants of the medical and nursing graduates to work in the rural areas included the desire to save lives (altruism), personal background (ease of communication) security, personal safety and opportunity for career advancement.
				Demotivating determinants of working in rural areas were inequitable and poor remuneration, high workload due to understaffing, no time for holidays, overwhelming responsibilities of clinical care, inadequate planning and heavy administrative work, low intellectual stimulation, inadequate supplies, equipment and supportive supervision, low access to continuing professional education, limited opportunities and discrimination in remuneration.
Mbilinyi et al., (2011) [42]	United Republic of Tanzania	To explore the challenges generated by human immunodeficiency virus (HIV) care and treatment and their impact on health worker motivation in Mbeya Region, Tanzania.	n = 30	Positive determinants of motivation (motivators) were mainly at the individual level, and the majority of the demotivators were at the organizational or health system structural level, with fewer demotivators being at the social-cultural environmental level.
Mbindyo et al., (2009) [11]	Republic of Kenya	To explore contextual influences on worker motivation, a factor that may modify the effect of an intervention aimed at changing clinical practices in Kenyan hospitals.	n = 185	Individual-level determinants of the healthcare workers’ motivation were altruism; appreciation; prestige from patients and family; professional attachment; sense of job security, especially in government; acquisition of career experience for career growth and development, and the challenge of meeting demands and expectations of patients.
				Organizational-level factors of motivation were resources and allocation, both human and non-human; relationship with colleagues and supervisors; fairness in treatment across cadres; incentives, both monetary and non-monetary; communication between hospital management and colleagues; recognition and appreciation, and commitment of managers to improving staff condition.
				Health system (structural)-level factors of motivation comprised schemes of service such as clarity of career progress, promotion, provision of allowances and salaries, career development possibilities and accessibility to training opportunities.
Mubyazi et al., (2012) [22]	United Republic of Tanzania	To describes the supply-related drivers of motivation and performance of health workers (HWs) in administering IPTp doses among other antenatal care (ANC) services delivered in public and private health facilities (HFs) in Tanzania, using a case study of Mkuranga and Mufindi districts.	n = 78	Key determinants of motivation/demotivation included poor working conditions of the health facilities (water, electricity, furniture); health worker shortage, leading to excess workload; shortage of essential drugs and supplies such as working gear and furniture. Private health facilities were more motivated because of better staff residences, better buildings, equipment, available clean water, electricity and cups for patients than public health facilities were. Public health facilities had more staff cadre such as clinical officers, nurses and midwives than private health facilities.
Mugo et al., (2018) [43]	Republic of South Sudan	To explore challenges and barriers confronted by maternal and child healthcare providers in delivering adequate quality health services to women during antenatal care visits, facility delivery and post-delivery care.	n = 18	Barriers to motivation in South Sudan included low salary, poor management and coordination, lack of supervision, shortage of healthcare workers, lack of training opportunities, lack of essential medical equipment, lack of security and absence of rewards (monetary e.g., bonuses or non-monetary incentives).
Prytherch et al., (2012) [20]	United Republic of Tanzania	To provide detailed understanding of the influences on the motivation, performance and job satisfaction of providers at rural, primary-level facilities were sought to inform a research project in its early stages.	n = 35	Key sources of motivation among the maternal and neonatal health (MNH) were community appreciation, perceived governmental and development support (per diems) and on-the-job learning (such as seminars and workshops).
				Prime sources of demotivation reported were mainly lack of fair compensation, unsupportive management, inflexible schedules, favouritism in promotions, uncertainty in transfer, poor security, poor health and safety, problems with accommodation and feelings of helplessness (due to lack of equipment and resources).
Ochieng et al., (2014) [44]	Republic of Kenya	To find out, from stakeholders’ perspectives, the type of tasks to be shifted to community health workers and the appropriate strategies to motivate and retain them.	n = 48	Strong motivators included close supportive supervision, means of identification, adequate resource allocation, continuous training and compensation.
Rudasingwa et al., (2017) [45]	Republic of Burundi	To what extent health workers are motivated and influenced by the Performance-Based Financing (PBF) scheme.	n = 36	Performance-based financing (PBF) motivated all the health workers and increased their teamwork and effort and enhanced their drive to change to implement best practice in their quality of service delivered.
Singh et al., (2016) [46]	Republic of Uganda	To understand whether full-time professional CHWs can potentially work with volunteers in the community to widen their reach and scope, and if so, what motivators might be of key importance to the community health volunteers (CHVs) remaining active in the field.	n = 81	Motivating determinants included desire to share health-related knowledge, relationship building, seeking health knowledge, being part of and seeing behavioural change within the community and the hope of gaining employment status.
Strachan et al., (2015) [47]	Republic of Uganda	The aim of this paper is to demonstrate how a behavioural theory, which accounts for the influence of group identification, in combination with data generated from qualitative interviews with CHWs and stakeholders, can be used to inform the design of interventions to improve CHW motivation, retention and performance in two settings—Uganda and Mozambique—with diverse, government-led HW programmes.	n = 87	The formative research in Uganda showed determinants of motivation were helping fellow community members; desire to provide proper healthcare services to the community; gaining their trust, respect and appreciation; learning; meeting new people; receiving validation and feedback from supervisors, and access to adequate resources such as drugs.
Stringhini et al., (2009) [48]	United Republic of Tanzania	To assess how informal earnings/payments might help boost health worker motivation and retention in Kibaha, Tanzania.	n = 64	Accepting of informal payment from patients to health workers had negative effects on health workers, access to and quality of health care services provided.
Takasugi et al., (2012) [49]	Republic of Kenya	This study sought to ascertain these motivational drivers.	n = 23	Both financial and non-financial motivational drivers were identified, including monetary and non-monetary rewards, specifically personal recognition, supportive supervision, personal development, training opportunities and good working conditions.
Witter et al., (2017) [50]	Republic of Uganda	To examine patterns in expressed motivation to join the profession across different cadres, based on 103 life history interviews conducted in northern Uganda, Sierra Leone, Cambodia, and Zimbabwe.	n = 26	Emerging determinants of motivation among the health workers were personal calling, professional status (admiration and respect), economically free tuition, perceived better pay, accommodation and transport, educational background, proximity to essential facilities and life events.