1.1 Background of the study

Motivation is a prerequisite for effectiveness and efficiency of health care delivery. Motivation may be described as the processes that account for an individual's intensity, direction, and persistence of effort toward attaining a goal. In most cases, motivation stems from a need which must be fulfilled, and this, in turn, leads to a specific behavior [1]. However, it is not only an inherent factor in individuals, but also a group incentive to act or not to act. It is defined as an intrinsic process that psychologically directs the behavior of an individual [2, 3]. Furthermore, Steers et al. [2] relate motivation to organizational performance. In the healthcare field, attaining health objectives in a population depends to a large extent on the provision of effective, efficient, accessible, viable, and high-quality services by healthcare professionals who, technically, are driven by motivation [1, 4]. In this era, the willingness of health record officers /employees to work and stay in an organization depends on the extent to which they are adequately motivated [5]. Ideally, every employee will put up a better performance if the incentive packages are rewarding and in line with the capacity to meet the needs of the individual. In this regard, while economic factors play a crucial role in the motivation and retention of health record officers, healthcare workers, including nurses, in healthcare facilities and other work posts [6], other factors are equally as important to keeping their loyalty. The workforce in the health sector has specific features that cannot be ignored, and motivation can play an integral role in many of the compelling challenges facing healthcare today. Nowadays, the task of motivating is complicated by the nature of the economic relationship between those using the system and the system itself (physicians, patients, and hospitals) and exacerbated by the management of the heterogeneity of the workforce. Some studies contend that health organizations are faced with external pressures that cannot be effectively resolved without appropriate adjustments to the workforce; thus, the development of the workforce appears to be a crucial part of the health policy development process. Motivation as a healthcare policy is an engine for development and growth in all facets of healthcare delivery in Ghana [6, 7]. In Africa, health record officers face a hierarchy of motivations or disincentives generated by the work they do, the way they are paid, and the organizational and system context in which they work. Motivational packages are generally designed to encourage providers to furnish specific services, encourage cost containment, support staff recruitment and retention; enhance productivity and the quality of services, and allow for effective management [8, 9]. According to the WHO, the African continent is currently facing a severe human resource crisis in the health sector which appears to have affected the delivery of quality and efficient healthcare services. Sub-Saharan Africa has the lowest health worker-to-population ratio in the whole world [10, 11]. This trend is getting worse according to country specific case studies because of internal and external migration. According to Dieleman et al. [12], the issue of low motivation in the work place is one major contributor to the brain drain of health workers from Africa to other countries and from rural to urban areas within the same country. For decades, researchers have been studying factors influencing performance in health organizations with emphasis on worker and work environment factors. Health record officers and Nurses constitute the largest human resource element in healthcare organizations [13] and therefore appear to have a great impact on the quality of care and patient outcomes. Job performance has often been examined in light of work attitudes such as job satisfaction and organizational commitment. Health workers’ attitudes toward their jobs and their commitment to their employers have interested researchers because of their impact on behavior at work and quality of patient care. In Saudi Arabia, interest has been growing on issues related to performance in health organizations as a reflection of the increasing interest in quality improvement [14]. Numerous scholars have investigated the performance of health workers in the context of motivation [15-22]. Some studies have focused on the contribution of health workers’ care to patient outcomes. The Herzberg theory states that factors which cause job satisfaction are the opposite of those that cause job dissatisfaction. Herzberg surveyed a group of accountants and engineers and came to the conclusion that employees are influenced by two factors, namely motivators and hygiene factors. Motivators, which include achievement, recognition, autonomy, and other intrinsic aspects, create job satisfaction when an individual is fulfilled. According to Herzberg, motivators pertain to job content; they are intrinsic to the job itself and do not result from “carrot and stick incentives”. They comprise the physiological needs for growth and recognition. The absence of these factors does not prove highly dissatisfying, but when present, they build strong levels of motivation that result in good job performance. They are therefore called satisfiers or motivators. These factors include achievement, recognition, advancement, the work itself, the possibility of personal growth, and responsibility. Motivators are those factors that provide a feeling of satisfaction at work and influence the way work is done in a company; for example, giving a person responsibility for a large task within an organization and providing that person with the necessary conditions will lead to his growth and advancement to higher-level tasks. Motivators that are intrinsic are those factors that come from within an individual. These factors could be achievement, interest in the task, responsibility of a large task, growth, and advancement to higher levels. Herzberg’s hygiene factors create a suitable work environment, though they will not increase satisfaction. The hygiene factors are also referred to as the maintenance factors and comprise the physiological, safety, and amity needs from Maslow’s hierarchy of needs. They are factors not directly related to the job but to the conditions that surround doing the job. They operate primarily to dissatisfy employees when they are not present. However, the presence of such conditions does not necessarily include these factors; company policy and administration, technical supervision, interpersonal relations with supervisor, interpersonal relations with peers and subordinates, salary, job security, personal life, work conditions and status. Herzberg called the abovementioned factors “hygiene factors”, since they are necessary to maintain a reasonable level of satisfaction but can also cause dissatisfaction. Hygiene factors are not direct motivators, but they are necessary to prevent dissatisfaction. At the same time, they serve as a starting point for motivation. However, improvements in these conditions do not create the necessary motivation [23]. For instance, low pay can cause job dissatisfaction, which will affect health record officers performance on an assigned task. Hygiene factors are essential to ensuring that the work environment does not develop into a disgruntling situation. The basic assumption of Herzberg’s two-actor theory indicates that the productivity of health workers on the job can be increased through worker satisfaction, and this comes from a variety of factors. For example, jobs should be challenging enough so that nurses utilize their full ability, and workers who are successful should be given more responsibility. This theory serves as the basis for effective work performance by health workers. In all human organizations, it is motivation that strengthens, directs, and sustains human behavior [23, 24]. An important addition to these definitions is that motivation may be influenced by factors that are intrinsic or extrinsic to the individual. However, since intrinsic factors are relatively hard to define, emphasis is often placed on the extrinsic factors, which include the ability of managers to satisfy an employee’s needs. The sections below explain both intrinsic and extrinsic forms of motivation. Intrinsic motivation is driven by an interest or enjoyment in the task itself and exists within the individual rather than relying on any external pressure. Intrinsic motivation is the motivation to do or act in one’s own interests or simply for the enjoyment of the activity itself [25]. Robbins describes it as the desire to work on something that is interesting, challenging, satisfying, exciting, or involving. Social and educational psychologists have studied intrinsic motivation since the early 1970s [26]. Explanations of intrinsic motivation have been given in the context of Fritz Heider’s attribution theory [27], work on self-efficacy [28], and cognitive evaluation theory. Intrinsic motivation is the innate and natural propensity to engage an individual’s interests and exercise an individual’s skills and capabilities, and, in so doing, to look for and achieve optimal opportunities and challenges [28]. This motivation comes from internal tendencies and can direct and motivate behavior without the presence of constraints or rewards. Extrinsic motivation comes from outside of the individual. Common extrinsic motivations are rewards like money and grades, coercion, and the threat of punishment. Competition is, in general, extrinsic, because it encourages the performer to win and beat others, not to enjoy the intrinsic rewards of the activity. A crowd cheering for an individual and trophies are also extrinsic incentives. Extrinsic motivation refers to performing an activity with a feeling of being pressured, tension, or anxiety to make sure that one achieves the desired result [29]. Hennessey and Amabile define extrinsic motivation as the motivation to do something to make sure that some external goal is attained or that some external imposed constraint is met. Extrinsically-motivated behaviors are actions that cause the attainment of rewards that are externally imposed, including material possessions, salary, added bonuses, positive feedback and evaluations from others, fringe benefits, and prestige [30, 31]. Socio-psychological research has indicated that extrinsic rewards can lead to over-justification and a subsequent reduction in intrinsic motivation. In one study demonstrating this effect, children who expected to be (and were) rewarded with a ribbon and a gold star for drawing pictures spent less time playing with the drawing materials in subsequent observations than children who were assigned to an unexpected reward condition and to children who received no extrinsic reward [26]. Motivation is an emotive state causing persons to want or need something intensely enough to put forth the necessary effort to achieve it.

1.2 Problem of the study

In Nigeria, there has been considerable progress in many health outcome indicators. However, these achievements were insufficient for attaining the targets for health-related millennium development goals. This is due to a number of factors, including understaffing in health facilities, inequitable distribution of health sector human resources, de-motivated staff and inadequate healthcare infrastructure. Attaining these health-related MDGs needs more comprehensive quality improvement interventions, including a health sector human resource (HSHR) approach [13]. Also, Staff/ health record officers have been accused of high level of inefficiency in the discharge of their duties by the general public and the Health Ministry. There is, therefore, a need to ascertain the impact of motivation strategies on the effective and efficient health care delivery among health record officers in University College Hospital Ibadan

1.3 Objectives of the study

The aim of the study is to examine the impact of motivation strategies on the effective and efficient health care delivery among health record officers in University College Hospital Ibadan.

The objectives are:

1. To identify motivational strategies by University College Hospital Ibadan for health record officers

2. To evaluate the effectiveness of these motivational packages on health record officers.

3. To how effective and efficient the health record officers are.

4. To identify the constraints mitigating the effectiveness and efficiency of health record officers.

1.4    Research Questions

          The followings are spelt out to be the research questions

     i.        What are the motivational strategies adopted by University College Hospital Ibadan for health record officers?

   ii.        How effective and efficient are these motivational packages on health record officers?

  iii.        What is the level of effectiveness and efficiency of health record officers in University College Hospital Ibadan?

  iv.        What are the constraints mitigating the effectiveness and efficiency of health record officers?

1.5    Research Hypotheses    

The following statements are considered to be the research hypotheses

Ho1: there is a significant relationship between motivational packages on health record officers and their effectiveness.

Ho2: The effect of motivational packages on health record officers University College Hospital Ibadan is significantly positive.

1.6    Significance of the Study

The study is expected to enable the researcher gain deeper insight into the motivational practices and its effect in University College Hospital Ibadan so as to contribute effectively in participatory decision making with respect to staff motivation, effectiveness, efficiency and performance. This research sought to provide the needed information that would guide the Management of University College Hospital Ibadan to better align their strategies on motivation with their health record officers performance measurement systems for optimum health record officers performance. The findings are expected to help inform decision making in the area of strategic planning with regard to health record officer’s motivation and performance. The study will be very useful to other researchers interested in the area of motivation. That is, the outcome of this study will serve as a base for academicians who want to conduct further studies on the impact of motivation strategies on the effective and efficient health care delivery among health record officers especially in the health sector for the betterment of the Health service in Nigeria. The outcome of this study is to augment the existing store of knowledge on the subject available and serve as a catalyst for further research on innovative ways of motivation for the overall academic well-being of the nation.

1.7    Scope of the Study

The study was conducted within the framework of evaluating the impact of motivation strategies on the effective and efficient health care delivery among health record officers in University College Hospital Ibadan. The study focused only on the health record officers in University College Hospital Ibadan. The study was carried out at the University College Hospital Ibadan. It is a case study approach of the health record officers and did not cover the Non-health record officers or other officers to reflect the entire industry approach to motivation on health record officers effectiveness and efficiency. Hence, the result will not be generalized but its findings would be placed in the relevant context of the individual institution studied.

1.8    Limitation of the Study

The researcher encountered problems in the course of the study, the problem ranges from financial constraints following the fact that the researcher is a student and there was no extra funding from the outside world for this project. Also getting approval from the management to carry out research on the topic took time. Nevertheless, the outcome of this research work is not hampered by the mentioned limitations.