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

## TL;DR

This review explores how cultural and organizational factors influence healthcare workers' motivation in Africa, emphasizing non-financial drivers like community trust and self-efficacy.

## Contribution

The study introduces a framework linking socio-cultural contexts to intrinsic and prosocial motivation in African healthcare workers.

## Key findings

- Autonomous motivation is influenced by positive work environments and community appreciation.
- Collectivistic values underpin intrinsic motivation among African healthcare workers.
- Lack of community belonging reduces self-efficacy and trust in healthcare workers.

## Abstract

In Africa, the poor quality of care is often attributed to a lack of motivated health workers (HWs). 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.

Following guidelines from Arksey and O’Malley, 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.

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 (IM) 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.

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.