Efforts to Change Provider Behavior

Melissa & Mary Warimu. Nairobi (17/04/12)There have been many efforts to change provider behavior and improve provider performance over the years, with much success. To date, most of the interventions that address provider behavior for improved performance – including their willingness and ability to adhere to policies and better practices – have targeted structural factors linked to worker environment, access to transportation, equipment, job aids and the availability of resources and direct incentives (payments, promotions and awards). Interventions have also sought to better manage provider workloads and improve their knowledge and skills through training (MCHIP, 2013).

While these types of external motivation interventions have been successful in improving provider performance, it is also known that highly motivated providers can often overcome obstacles such as poor working conditions and inadequate equipment. A growing body of evidence shows that providers have a number of internal motivating factors that must also be addressed to change their behavior.


Internal motivations are often influenced by a number of factors including: personal attitudes and beliefs, social norms, personal and community values, status within the community and within the health system, perceived importance of work, recognition, and feelings of connectedness and social cohesion among supervisors and peers.

This I-Kit will focus primarily on addressing internal motivational factors. There are three reasons for this focus:

  1. Internal motivation is often neglected in programs seeking to change provider behavior.
  2. Motivation as a driver of behavior is a combination of psychological, interpersonal and contextual factors that make it uniquely suited to SBCC interventions.
  3. A number of tools and resources already exist that help program planners address the external motivation factors.

Internal Motivation

Personal needs met (e.g. status, perceived social support, self efficacy, personal rewards), supportive social and gender norms, personal values and attitudes, feeling of connectedness to community and health system

External Motivation

Adequate resources available, supportive policies, health system responsiveness, available training, timely and appropriate feedback from supervisors

Influencing HEWS in Ethiopia

When female Health Extension Workers (HEW) in rural Ethiopia were asked how a program could sustain HEW volunteerism, many highlighted the importance of non-financial incentives to improve their motivation. HEWs suggested strategies that would promote their work among community members. Suggestions included community outreach to communicate the significance and voluntary nature of their work; public certification and award ceremonies that would recognize them for their contributions to community health; and strategically engaging influential community and religious leaders to publicly promote HEWs.  All of these can be effectively addressed by SBCC.

Last 10 Kilometers Project, Working Paper No. 1. JSI, 2009.