Health Worker Motivation in Georgia: Contextual Analysis

Abstract

This paper represents the first phase of a larger study examining health worker motivation in two hospitals in Tbilisi, Georgia. The paper analyzes the context within which health workers are located and describes historic trends in the position of health workers and the current efforts to reform the health sector. It also provides a detailed analysis of work conditions and organizational features of the two study hospitals. Data was collected through literature review and in-depth interviews. The paper is designed to be read in conjunction with further, individual-level analyses of the determinants and consequences of worker motivation in Georgia. Very radical changes have taken place in the position of health workers in Georgia since the breakup of the Soviet Union. Health workers were formerly accustomed to regularly paid and relatively adequate salaries; however, since the break-up, formal salaries have declined dramatically, leaving health workers largely dependent upon earnings from informal incomes. The highly developed Soviet system of promotions and rewards for good performance has also disintegrated and workers are now paid based purely on the quantity of services they provide. Funding for all aspects of health care has declined, leading to resource shortages and poor maintenance of facilities. It is not surprising that in this resource-starved context workers appear to place considerable importance upon social relationships in the work place.