One of the most common problems I see working in the public health system is depleted motivation and engagement. It’s a fundamental challenge to creating and maintaining a strong and responsive public sector. The causes for this vary: lack of formal incentives, an unappreciative organizational culture and an ossified bureaucracy. But the impact is singular: poor health outcomes.
But there are exceptions! Recently I went to an Urban Primary Health Centre (UPHC) in Jaipur and met a Medical Officer who ran a very-patient centric operation. He said he has a good relationship with his community, and he himself enjoys seeing patients get well. No-one in the facility is allowed to be rude or speak harshly to the patients. He said: No-one wants to come to the doctor. If they come, they are in pain and we should not cause them more pain”.
The benefits of this approach are visible in his many regular patients – through the NCD screening, he has many patients with chronic conditions (diabetes, hypertension) who come back to see him regularly. He was also mindful of the challenges his patients faced in care-seeking – telling us that if they needed a diagnostic test at the hospital – they would lose 3-4 hours just waiting around. For this reason, he strongly advocated for more services to be available at the UPHC level.
Of course this MO is not an isolated case. But I am recounting his story – because it’s not a norm either.
What are the facilitating factors? His UPHC also has an established relationship with the local medical college where he gets support from faculty and interning students. He has a good team in place. There is a relatively supportive system backing him up. Rajasthan has a dynamic health system with free essential medicines, and 14 free diagnostic tests at the UPHC level. This support to the health system has been provided by successive governments – first Congress and now a BJP government. This proves a good health system has a political benefit we wish more politicians would realize.
It would be great if all health workers could get the support required to maintain motivation and engagement. In the meantime, we should celebrate those that have remained committed even in the context of system constraints.
More things to read about motivation and engagement:
Dan Ariely’s Payoff is an excellent little book and a quick read. It describes how a sense of purpose and meaning – and appreciation – can be more important than financial rewards.
See my entry on Daniel Pink’s Drive here in my blogpost about most inspiring public health books.