How Organisational and Socio-Cultural Contexts Shape Healthcare Workers' Intrinsic, Prosocial, and Public Service Motivation in Africa: A Scoping Review

Articles in Press

Document Type : Review Article

Authors

1 Mohammed VI International School of Public Health, Mohammed VI University of Sciences and Health, Casablanca, Morocco

2 Public Health and Management of Health, Mohammed VI Center for Research & Innovation, Rabat, Morocco

3 Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium

Abstract

Background 
In Africa, the poor quality of care is often attributed to a lack of motivated health workers (HW). Most reforms implemented in African health systems rely on performance-based financial incentives. Evidence suggests that financial incentives may have adverse effects, such as crowding out autonomous forms of motivation, including intrinsic, prosocial, and public service motivation (PSM). We aim to map conceptual definitions of autonomous motivation and unpack the relationship between context and societal culture in shaping the motivation of HW in Africa.
 
Methods 
Following guidelines from Arksey and O’Malley (2005), we conducted a scoping review of peer-reviewed publications from 1990 to 2024 using the databases (Web of Science, Scopus, Google Scholar, and PubMed). We used the Intervention-Context-Actor-Mechanism-Outcome (ICAMO) heuristic to identify plausible causal pathways linking context and societal culture to HW motivation.
 
Results 
Scholars defined PSM as a complex dynamic process that stimulates individuals to carry out self-altruistic and prosocial behaviours. Our review showed that autonomous motivation is sensitive to context. Enabling conditions include a positive work environment, community appreciation, and local context. Our review suggests a form of intrinsic motivation for HW in Africa that may be rooted in collectivistic values, such as the willingness to serve the community to which they belong. When HW perceived a lack of belonging to the community they serve, they reported being disregarded, which reduced their sense of self-efficacy, self-esteem, and trust in their community relationships.
 
Conclusion 
This review highlights how context and societal culture can reinforce the trust relationship between HW and communities, thereby increasing HWs’ motivation by enhancing their perceived self-efficacy and autonomy. Our findings suggest that exploring the role of decentralisation, trust relationships, and self-efficacy in expressing autonomous motivations are research priorities.

Keywords

International Journal of Health Policy and Management

Articles in Press, Accepted Manuscript
Available Online from 19 August 2025

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History

  • Received Date: 21 October 2024
  • Revised Date: 02 August 2025
  • Accepted Date: 16 August 2025
  • First Published Date: 19 August 2025

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