1  

 

  

ENSIGN COLLEGE OF PUBLIC HEALTH  KPONG 

EASTERN REGION  

  

  

  

INFLUENCE OF MOTIVATION ON HEALTH  

WORKER PERFORMANCE AT HO MUNICIPAL  

HOSPITAL, HO IN THE VOLTA REGION OF  

GHANA   
  
  
  

BY   
  

MABEL ADOM    

  
  

A Thesis Submitted to the Department of Community Health in the  

Faculty of Ensign College of Public Health in Partial Fulfillment of the 

Requirements for the Degree of  

  

MASTER OF PUBLIC HEALTH   

  

 JUNE 2020  



 

  

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14-06-2020 

 

 

DECLARATION AND CERTIFICATION   

I, Mabel Adom, declare that this submission is my own work towards the MPH and that to the best 

of my knowledge, it contains no material previously published by another person nor material 

which has been accepted for the award of any other degree of the University, except where due 

acknowledgment has been made in the text.    

  

Mabel Adom                                                   12/06/2020 

Student’s name                                Signature                       Date  

 

Student’s ID   MPH 187100139       

  

  

Certified by:  

Dr Edward Sutherland                                                   14/06/2020  

Supervisor’s name          Signature                                                 Date  

  

  

  

………………………...   



 

  

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Dr Stephen Manortey     ………………………….    ………………..  

Head of Academic Programme           Signature                Date  

DEDICATION 

This research work is dedicated to God of Major 1, to my brother Mr Newell Yao Soglo of E. P. 

University College, Ho. and my lovely Sister Vivien Eunice Gedzie my mentor. My Soulmate Mr 

Frank Haizel and my two lovely children Makafui and Dereck for their priceless love, support and 

encouragement which enabled me to pursue this programme to a successful end.   

   

   

  

  

  

  

  

  

  

  

  

  

  

  

  



 

  

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ACKNOWLEDGEMENT   

First and foremost, I am grateful to the Almighty God for His mercies and protection without which 

this research work could not have been possible. I also like to express my profound gratitude to 

my supervisors Dr Edward Sutherland and Dr Stephen Manortey for their precious time, useful 

remarks, valuable insights and expert guidance throughout this work. Your patience, 

encouragement, monitoring and proposals, as well as faith in my ability had motivated me and 

allowed me to successfully complete this work on time.  

Special thanks go to Ensign College of Public Health Management for giving me the opportunity 

to undertake my graduate studies. I am thankful to all my lecturers at the Ensign College of Public 

Health for being helpful and for imparting knowledge to me in diverse ways throughout my study. 

My heartfelt appreciation as well goes to my friends and critics for sharing their expertise and 

providing insightful suggestions that helped to improve this research work.    

  

  

  

 

 

 

 



 

  

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TABLE OF CONTENTS  

CHAPTER ONE  

 1.0.   Introduction ………………………………………………………… 12  

1.1.      Background ……………………………………………………….. 12  

1.2.      Statement of the problem………………………………………….. 13  

1.3.      Rationale of the study …………………………………………….. 15  

 1.4.      Conceptual framework ….………………….………………………16    

1.5.      Research Questions…………………………………………………  17  

1.6.      General Objectives ………………………………………………... 18  

1.7.      The Specific Objectives …………………………………………... 18  

1.8.       Profile of Study Area ……………………………………………… 18  

1.9.      Scope of the Study ………………………………………………..  19  

 1.10.    Organization of Report ……………………………………………  19  

CHAPTER TWO   

 2.0.     Literature Review ……………………………………………….…  20  

 2.1.     Introduction  ……………………………………………………….  20  

 2.2.     Health System Performance ………………………………………  20  

 2.3.     Employee’s Performance…………………… ……………………  21  

 2.4.     Employee’s Motivation .…………………………………………..  24  

 2.5.     Intrinsic Motivation ………………………………........................  26  



 

  

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 2.6.     Extrinsic Motivation…………………………………….………...  27  

 2.7.     Classification of Motivation ..……………………………………..  29  

 2.8.     Theories of Motivation ……………………...…………………….  31  

CHAPTER THREE    

 3.0.  Methodology  ……………………………………………………....  43  

 3.1.      Introduction  ………………………………………………………..   43  

 3.2.      Research Methods and Designs …………………………………....  43  

 3.3.      Data Collection Techniques and Tools ………………………….…    44  

 3.4.      Study Populations …………………………………………………..  45  

 3.5.       Inclusion Criteria ..…………………………………………………  46  

 3.6.       Pre-testing …………………………………………………………..  47  

3.7.       Data Handling ………………………………………………………. 48  

 3.8.       Data Analysis  ………………………………………………………  48  

3.9.       Ethical Considerations ……………………………………………… 48  

3.10.  Assumptions  ……………………………………………………….. 48  

CHAPTER FOUR   

4.0.       Results  …………………………………………………………….. 50  

4.1.      Introduction …………………………………………………………  50  

 4.2.  Demographic Data …………………………………………………  51  

 4.2.      Link between Motivation and Performance.……………………….  68  

CHAPTER FIVE   



 

  

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 5.0.   Discussions ………………………………………………………...  70  

CHAPTER SIX   

 6.0.   Conclusion and Recommendations …………………………………..  77  

 6.0. Conclusion ……………………………………………………………  77  

6.1. Recommendation ……………………………………………………..  78  

         References ……………………………………………………………. 82  

 Appendices  …………………………………………………………..  91  

 Appendix One: Questionnaire………………………………………..  91  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  



 

  

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LIST OF FIGURES  

  

Figure 1: Conceptual Framework: ….…………………………………………  17  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
 



 

  

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LIST OF TABLES 

  

Table 2.1:   Summary of the Trichotomy of Motivation …………………………...29  

Table 4.1:  Age breakdown of respondents ………………………….....……….....51  

Table 4.2:  Results of highest qualification of respondents …………... ………......53  

Table 4.3:   Results showing how long respondents have been working in the   

facility ………………………………….……………………………....54 

Table 4.4:  
Working with little or no supervision motivates me to improved  

performance …………………………………..………………………..55  

Table 4.5:   My achievement and personal satisfaction in my work enhance(s)   

my performance ………………………….………………………….….56  

Table 4.6:   Continuous education through training and development will help  

improve my skills and influence(s) performance………………..……..57  

Table 4.7:    Job security helps to enhance performance ..……………………..……58  

Table 4.8:   Good interpersonal relationship with coworker enhance work   

performance ………………………………………………………..…. 59  

Table 4.9:  

Responsive/Friendly service offered by workers in this facility  

enhance client’s satisfaction and quality of care delivery in the  

hospital…….............................................................................................60  

Table 4.10:   Availability of adequate number of health workers at the facility to  

deliver the service improve quality of health care delivery……………..61   

Table 4.11:  
My knowledge and skills help to improve safety of patients and  Influence 

quality of health care delivery …………………………………………..62 

Table 4.12:  
Incentive package at the Ho Municipal Hospital helps me to improve          

My performance ………………………………………………………...63 

Table 4.13:  
Availability of materials and equipment for my work including safe       

Work environment help to improve my work……………………… …..64 

Table 4.14:  Recognition and promotion have been a major factor for motivating     

Staff to improve performance …………………………………………...65    

Table 4.15:   Improved salary is enough to meet my normal expenses and   

influence my performance……………………………………….………66 

Table 4.16:  Availability of drugs and equipment increase productivity which 

influence(s) quality of health care delivery……………………..…….....67  

Table 4.17:  I see link between motivation and performance……………………..…..68  
  



 

  

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ABSTRACT  

The role of motivation in enhancing performance levels of workers can hardly be underestimated. 

This study assessed the impact of motivation on the performance of health workers at the Ho 

Municipal Hospital. Specifically, it sought to find our whether motivation had any effect on the 

performance of the clinical staff of the hospital. A descriptive survey research was adopted as the 

research design with one hundred and ninety- four out of two hundred and nine staff responding 

constituting 93% response rate.  

The data from the questionnaire administered were coded and analyzed using STATA version 14 

software. Tables were used to depict results obtained from the respondents. The study examined 

both intrinsic and extrinsic motivators which, in the view of the respondents influenced their 

performance levels.   

For intrinsic, the study revealed that respondents were intrinsically motivated by knowledge and 

skills acquisition, continuous education, environment and personal satisfaction as well as working 

with or without supervision. Extrinsically, it was found that health workers were enthused about 

improved salary, incentive packages, recognitions and promotion as being motivators that 

enhanced their performance levels.  

The study thus accepted a positive relationship between motivation and performance. In order to 

sustain health workers’ motivation levels for enhanced performance and quality service delivery, 

it was recommended that a policy be put in place by health sector managers to ensure equity, 

fairness and transparency in administering issues of motivation.  

Finally, it was proposed that in looking at motivation, and for it to have a lasting effect on 

performance, both intrinsic and extrinsic motivation should be explored.   



 

  

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CHAPTER ONE  

INTRODUCTION  

1.1 Background Information  

One of the most important factors that move every human being to achieve their goal is motivation. 

It is that guiding principle that enables people to stay focused on the path of success regardless of 

the challenges that may be encountered. Globally, many organizations are relying on employees 

for success and competitiveness (Armstrong, 2011). Hence, motivation has become a familiar 

concept and is being used by most organizations as a tool for organizational success all over the 

world. Understanding what motivates an employee has always been a key challenge for managers, 

but considering the importance of it for an organization’s success, one has to continuously attempt 

to understand it better. With human capital gaining prominence over financial capital in the recent 

times, it becomes all the more important. Today, the competitive advantage of a business is 

determined by its people. Hence, the use of good motivation is becoming more and more critical 

(Armstrong, 2011). According to psychologists, motivation is a force that determines the direction 

of the person’s behavior, level of effort and performance in an organization (Cerasoli, 2014). From 

the management perspective, it drives efforts to satisfy the needs, desire and wishes of individuals 

(Armstrong, 2011). Staff motivation, therefore, in institutions refers to the organized efforts and 

activities aimed at making the staff happy, healthy and duty conscious in order to inspire, help and 

encourage them perform to their level best (Bhuvaniah et al., 2015). In organizations, staff 

motivation and welfare help to uphold the staff firmly together and inspire them to achieve set 

goals.  



 

  

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Motivation could be intrinsic or extrinsic. Intrinsic motivation derives from within the person. It 

refers to the direct relationship between a worker and the task, and is usually self- applied. 

Examples of intrinsic motivation are achievement, challenge and competence which are derived 

from performing one’s job well (Anitha, 2013). Extrinsic motivation comes from the work 

environment, external to the person and his or her work. Good salary, fringe benefits, enabling 

policies and various forms of supervisions are good examples of this type of motivation 

(Rheinberg, 2018).  

  

1.2 Problem Statement  

The debate about motivation rotates around the idea that if an employee is happy with his/her work 

and working environment, he/she is bound to perform better, enjoy a stronger bond with the job 

and organization and thus is sustained for a longer time period (Dessler, 2011).   

  

This becomes mostly important in the service sector where the employee is directly in contact with 

the recipients of the service. This idea may further be translated into the realm of health, where a 

health worker can be said to play a fundamental role in ensuring health care. The scope of influence 

of health workers stretches over various aspects of a client’s life. As a result, Chudi-Oji (2013) 

posits that workers must be well motivated to ensure they are emotionally content with their job. 

This will enable them to positively impart what they do as well as the environment within which 

it is disseminated.  

  



 

  

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In Ghana, over the years, efforts have been made by successive governments to satisfy health 

workers’ needs and increase their motivation on the job. Among them are health workers’ 

performance based awards schemes, study leave with pay, provision of accommodation among 

others. In spite of these commendable efforts by governments to promote motivation among health 

workers, there is still the impression that health care staff still grapples with problems of motivation 

in the country. This may be seen in the various strike or threats of strike actions embarked on by 

health workers in recent times  

(Adzei et al, 2012). The Ho Municipal Hospital is a government hospital located in the Volta 

Region of Ghana which aside from government incentives also strives to motivate its healthcare 

workers through several means like provision of lunch, residential accommodation and continuous 

staff development programmes.   

  

The question however remains as to the influence of motivation on health worker performance at 

the hospital and factors driving it. To date, there has been no such research conducted at the 

hospital. There is need for managers at all levels to think of how to get their workforce to work 

towards achieving their organizational goals of providing quality health care to meet the 

expectations of clients and to achieve the Millennium Development Goals (MDGs) now 

Sustainable Development Goals (SDGs) (WHO, 2015). This study therefore looks at the impact 

of motivational factors on health worker performance in service delivery using the Ho Municipal 

Hospital in Ghana as a case study. The research will generate empirical evidence which will help 

guide the Hospital administration and managers of similar hospitals in achieving their 

organizational goals of providing quality healthcare services  



 

  

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1.3 Rationale of Study  

Motivation has been considered as an important subject all over the world as it is necessary for the 

growth of health systems and the development of societies all over the world. This has led to some 

researches being carried out on the topic by various authors. For example, the objective of a paper 

by Mosammod and Nurul-Kabir, (2011), was to evaluate motivation of employees in different 

pharmaceutical companies in Bangladesh. The primary focus was on the relative importance of 

motivational factors and their impact on the overall job satisfaction of employees. It also 

investigated the impact of pharmaceutical type, work experience, age, and sex differences on the 

attitudes toward motivation. The result indicated that salary, efficiency in work, supervision, and 

co-worker relation were the most important factors contributing to motivation.  

  

In their study, Javed et al., (2014), tried to examine the motivation level of employees to help 

organizations to know about the elements that influence motivation. The results showed significant 

positive association of employee empowerment, work place environment, job loyalty and job 

performance with job motivation. From the studies illustrated above, it is evident the issue of 

motivation plays an important role with regards to performance. In the context of this study, as 

compared to the ones presented, the results of this study provides useful information to the Ho 

Municipal Hospital authorities as to what motivational factors amongst its health delivery staff 

drive quality service outcomes and thus the attainment of organizational objectives in their unique 

setting. It is also instructive in that managers of the health sector would be aware of the role of 



 

  

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motivation and therefore apply same in various other health facilities to engender desired goals of 

the sector.    

1.4 Conceptual Framework for Health Worker Motivation and Performance The model 

developed below by Mohd et al., (2012), explains how applying compensation on ability can 

influence job performance. It shows arrows from the two main types of motivation to how an 

employee will be satisfied due to motivation received and also how motivation impacts on job 

performance. To Mohd et al., (2012), whilst extrinsic motivation relays to external environment, 

the intrinsic motivation on the other hand are those psychological motivations. Though all the 

types of motivation according to researchers (Mohd et al, 2012; Njanjal et al, 2013; Ngui et al, 

2014) impact positively on performance, many researchers lamented that indeed an extrinsically 

motivated person will be committed to his work as they view the job as tasks that are rewarding to 

him (Law et al., 2017). Thus an extrinsically motivated person will be committed to the extent that 

he can gain or receive external rewards for his job.  

  

Law, et al., (2017). further suggested that for an individual to be motivated in a work situation 

there must be a need, which the individual would have to perceive a possibility of satisfying 

through some reward. If the reward is intrinsic to the job, such a desire or motivation is intrinsic. 

However, if the reward is described as external to the job, the motivation is described as extrinsic. 

Other studies suggest that the self-reinforcing relationship also could work for intrinsic motivators 

(Zhang et al, 2018; Vallerand et al, 2011).  

  



 

  

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The relationship between employee motivation and job performance has been studied for a long 

period with the conclusion that employee motivation and performance are indeed related (Thibault 

et al., 2017).  In the work of Thibault et al.,(2017), performances are dependent upon the 

individual’s level of motivation; the individual’s level of motivation can be intrinsically and or 

extrinsically based.  This conceptual framework can apply to health workers, the health service 

and in the enhancement of performance. For instance if health care workers are properly motivated 

both financial and non-financial, chances are that performance levels will soar.   

  

Figure 1: Conceptual Framework for Health Worker Motivation and Performance  

 

     Source: Thibault et al., 2017  

  

1.5 Research Questions  

The study sought to provide answers to the following questions:  

1. To what extent does intrinsic motivation influence health workers’ performance at HMH?  

2. How does extrinsic motivation affect the performance of health workers at the HMH?  

3. Is there a relationship between motivation and performance of health workers?  

 

  

  

  

  

  

Extrinsic    

Motivation    

Intrinsic    

Motivation   

  

Motivation   

    

Job    

Performance  



 

  

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1.6 General Objectives  

The general objective of this study is to assess the impact of motivation on the performance of 

health workers at the Ho Municipal Hospital (HMH) in the Volta Region.  

  

1.7 Specific Objectives  

1. To examine how intrinsic motivation influences health workers’ performance at the HMH  

2. To determine the influence of extrinsic motivation on the performance of health workers  

3. To establish if a relationship exists between motivation and performance  

  

1.9 Profile of the Study Area  

The study was carried out at the Ho Municipal Hospital in the Volta Region of Ghana. Before 

February, 1999, the Ho Municipal Hospital was the Volta Regional Hospital. The hospital being 

the municipal health facility is the final referral point in the municipality. It is a one hundred and 

forty (140) bed capacity hospital with a staff population of two and ninety-six (296). The services 

available in the hospital include; out-patient department (OPD), emergency, surgical, obstetrics 

and gynecological, pediatric, laboratory, laboratory, psychiatric, radiology, blood transfusion, 

chest clinic and internal medicine among others.  

Referrals are received from all over Ghana that is from other districts, regions, and beyond.  

 1.10 Scope of the Study  

The study was limited in context to factors influencing motivation, intrinsic and extrinsic forms of 

motivation as well as the link between motivation and performance.  



 

  

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Geographically, the study covered the staff of Ho Municipal Hospital.   

1.11 Organization of the Study  

This study is organized into six chapters.    

Chapter one introduces the research through background of the study, statement of the problem, 

rationale of the study, research questions, objectives of the study, significance of the study, scope 

of the study, and organization of the study. Chapter two comprises the literature review which 

looked at relevant literature to obtain detail knowledge on the topic under study.  Chapter three 

focuses on the methodology employed in the study. This involves research design, study 

population, study variables, sampling, sampling techniques, data collection tools, and data 

analysis. Chapter four presents the results of the study. Chapter five discusses the findings of the 

study and chapter six outlines the study conclusions, and recommendations.  

CHAPTER TWO 

LITERATURE REVIEW  

2.1 Introduction  

This chapter provides a review and analysis of theoretical and empirical frameworks of motivation 

and performance at the workplace. The chapter highlights the following among others: health 

sector performance, employee performance and motivation, intrinsic and extrinsic motivation, 

theories of motivation and performance and performance measurement.  

  



 

  

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2.2 Health System Performance  

Health service performance is crucial to the growth and development of countries and therefore, 

the survival of the populations in these countries (Ebuehi et al, 2011). It is through the good 

performance indicators of the health sector that the well-being of people is assured.  

  

Mullei et al,, (2010), identifies the 7s namely; strategy, structure, skills, style of management, 

systems and shared values as key interrelated factors determining the performance of an 

organization and by extension, the health sector. The HR elements in this (staff, skills, shared 

values and structure) can be expected to play a significant role in changing organizational 

performance. These authors argued that the most common words used to assess the impact of these 

related elements are efficiency, effectiveness and quality which should translate into better 

performance of health service workforce. It is likely that, the implications of these words are to 

question the extent to which the human resources are well-managed, properly trained, motivated, 

appropriately skilled, sufficient to undertake the required work and well  

– supported in their (working conditions) environment.  One should also be interested in the extent 

to which the activities of the health service elements or institutions result in: reduced morbidity, 

lowered preventable mortality, less evidence of recurrent illness and increased health awareness 

(Adzei  et al., 2012). Interest may also be on the extent to which the activities undertaken by the 

institutions or elements of the health service are appropriate to skills available, case loads and type 

of population and their needs. All of these factors provide some measure of quality of management 

of those responsible for HR and of the likely performance of the workforce (Adzei et al., 2012).  

  



 

  

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Overall, indicators should be seen as one part of a wider approach to improving HR and health 

service performance involving: identifying and supporting desired improvements in the service 

performance and creating an environment in which achieving these improvements is seen to be 

desirable and worthwhile to managers in the service (Ghana Health Service, 2014).  

  

2.3 Employee Performance  

Performance is the accomplishment of work assignments or responsibilities of individuals.  

It is a person’s ability to perform all the tasks and duties required. It is one’s ability to exert a 

certain level of energy to get a job or task done (Whitman et al., 2010). There will be zero 

performance if no energy is spent. In other words, in the views of these authors, performance as 

the accomplishment of work assignments or responsibilities should contribute to the organizational 

goals, including behaviour and professional demeanor (actions, attitude, and manner of 

performance) as demonstrated by the employees approach to completing work assignment. It refers 

to the actual effort that the individual undertakes in order to carry out the work.   

  

Performance is often defined simply in output terms and in the achievement of quantified 

objectives but performance is a matter not only of what people achieve but how they achieve it.  

Imre et al., (2014), confirmed this by including the phrase ‘carrying out’ in their conception of 

performance, indicating that accomplishment, execution, carrying out, working out of anything 

ordered or undertaken cannot be lost on performance. High performance results from appropriate 

behaviour, especially discretionary behavior, and the effective use of the required knowledge, 

skills and competencies (Mohd et al., 2012). Performance management must examine how results 



 

  

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are attained because this provides the information necessary to consider what needs to be done to 

improve those results.   

  

The concept of performance has been expressed by Hannay, (2010), as he noted that performance 

means both behavior and results. Behaviors emanate from the performance and transform 

performance from abstraction to action not just the instruments from results, behaviors are also 

outcomes in their own right, the product of mental and physical effort applied to tasks- and can be 

judged apart from results. This definition of performance leads to the conclusion that when 

managing performance both inputs (behavior) and outputs (results) need to be considered.   

  

Dessler,(2011), contends that many people associate performance with the ability of the employee 

himself to determine the quantum of work done. According to Dessler (2011), an employee’s 

performance is based on individual factors, namely: personality, skills, knowledge, experience and 

abilities. Whilst it can and often does indeed include work quantity, it goes far beyond it, in that, 

performance looks at both quantitative and qualitative results of work achieved by an employee in 

carrying out their duties according to responsibilities assigned.  

  

Employee performance plays an important role in the organization’s performance. It comprises 

what the employee does or does not do. Performance involves quality of output, quantity of output, 

timeliness of the output, cooperation and the presence at work (Ngui et al., 2014). Employee 

performance can be defined as the record of outcomes achieved for each job function during a 



 

  

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specified period of time (Anitha, 2013). However, performance could be measured by variety of 

parameters which show an employee’s pattern of performance over time.   

  

Performance in the organization context is usually defined as the extent to which an organizational 

member contributes to achieving the goals of the organization. It involves an organization 

communicating its mission and strategies to the employees, setting individual performance targets 

to meet the employees as well as the organization mission. The continuous review of performance 

management ensures organizational performance (Ying 2012).   

  

2.4 Employee Motivation  

 The word motivation has been derived from the word motive which means any idea, need or 

emotion that prompts an individual into action. Heckhausen (2018), also defined motivation as the 

force within an individual that accounts for the level, direction, persistence of effect at work. Thus, 

this can ignite, direct and or maintain behaviour. To Heckhausen, (2018), motivation is a person’s 

active participation and commitment to achieve the prescribed results which obviously will require 

some amount of incentives. That is why in this study, the variable; motivation involves both 

intrinsic and extrinsic motivators. It is of relevance to argue that the concept of motivation is not 

as easy to comprehend. No wonder its practice in the world of work still remains challenging. 

Confirming this complexity, Rheinberg et al., (2018), propose that the concept of motivation is 

abstract because different strategies produce different results at different times and there is no 

single strategy that can produce guaranteed favourable results at all times.   



 

  

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Kuglanski et al., (2018), in confirming the views of Rheinberg et al.,(2018), posited  a strategy of  

motivation being the willingness of an employee to contribute high levels of efforts towards his or 

her work, conditioned by the capacity of the effort to satisfy needs as well as his or her personal 

environment.  By implication, a motivated employee ought to exhibit an effort to get things done. 

This active participation and commitment to achieve results is what is the bottom line. Basically, 

from the above views, employee motivation is seen as the inner drive or push that leads to a certain 

human action or inaction in a given time, given specific prevailing conditions. It is a force that 

considers individual inner drive in the pursuit of pushing people to do something in turn 

(Armstrong, 2011).  

However, the process of motivation usually starts with someone recognizing unsatisfied needs, 

then establishment of a goal to be achieved and thus satisfying the need and accomplishing the 

goal (Zhang, 2018). Motivation can also be affected by the social context. This context comprises 

the organization values and culture, leadership and management as well as groups or teams in 

which people work (Nyambegera, et al., 2016; Nguyen et al., 2019). These attitudes or values may 

greatly discourage academically able young men and women from enrolling in health related 

training courses. By the same yardstick, many health workers may also resort to other employment 

opportunities that will make them more comfortable. Motivation is closely related to job 

performance not merely job satisfaction which is a characteristic of motivated employees or quality 

of work life improvement programs (Kim, 2017). Thus, for a health institution to have a motivated 

workforce, they need to create an environment in which higher levels of motivation is maintained.   

The motivation of health workers is crucial for every society and this fact has been underlined 

variously by different scholars. Adzei et al. (2012), Ebuehi et al., (2010), Nyambegera et al., (2016) 



 

  

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and World Health Organization (2010) have perceived health worker motivation as an inspiration 

or encouragement for them to do their best in the workplace. Law, (2017), has conceptualized 

motivation as being located in the forces that bring about the arousal, selection, direction, and 

continuation of behavior in the worker. In this study, health worker motivation is considered as 

tangible or intangible working conditions that have the potential to influence health workers 

positively to demonstrate desirable behavior leading to a high quality professional practice and 

performance. Desirable behavior includes positive attitudes towards clients and encouraging 

positive perceptions of employer and work conditions and beliefs about self as a valuable 

professional health worker.    

  

2.4.1 Intrinsic Motivation  

It is an inducement from within a person that positively affects behavior, performance and well-

being. Intrinsic motivation is said to exist when behavior is exhibited for its own sake rather than 

to obtain material or social reinforcement (Cerasoli et al., 2014). In this study, intrinsic motivation 

of health workers include job satisfaction which is derived from the various health professions, 

enjoyment of the profession, challenges and competitive nature of work, recognition and career 

development, and control over others.  

These are the self-generated factors that influence people to behave in a particular way or move in 

a particular direction. These include autonomy, responsibility, challenge, ability, interest among 

others. This type of motivation will have a deeper and long term effect inherent within individuals; 

not imposed from outside and more subtle and hard to measure (Law, 2017).   



 

  

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Intrinsically motivated behaviors are seen when there is no other apparent reward except the 

activity itself and what people will do without external inducement. Instances of intrinsic 

motivation according to Thibault et al, (2017) are hunger, a sense of duty, altruism, and a desire to 

feel appreciated.    

Hung et al., (2011), stated that intrinsically motivated behaviors are innate and can result in 

creativity, flexibility, and spontaneity while extrinsically motivated behaviors are generally done 

as a consequence of pressure and result in low self-esteem and anxiety. However, even the mere 

identification of intrinsic /extrinsic behaviors has been a topic of debate (Rheinberg et al., 2018; 

Kim, 2017; Rogstadins et al., 2011). Despite this, the distinction between intrinsic and extrinsic 

motivation is an important one given their impact upon each other.   

Taking these findings into the realm of motivation in organizations, managers and those in charge 

of motivating employees must be aware of the fact that by simply applying extrinsic motivation 

methods without also addressing intrinsic factors, they could be doing more harm than good. In 

the same way, managers must understand that by simply rewarding workers through extrinsic 

means, they are actually perpetuating a destructive cycle of continual reward and decreased 

intrinsic motivation (Kroll et al., 2015).   

  

2.4.2 Extrinsic Motivation  

This has to do with what is done for people to motivate them. This includes rewards, praise, 

promotion, and punishment.  This type of motivation will have an immediate effect, but might not 

last long, and rival organizations may easily replicate them (Armstrong, 2011)   



 

  

26  

  

Extrinsic motivation is an externally administered reward as in wages, salaries, accommodation 

among others (Locke, 2018). In other words, a critical point to underscore is that extrinsic does 

not mean outside the person but rather outside the task; it pertains to what a chosen activity can 

lead to (Rheinberg &Engeser, 2018).  

Heckhausen (2018) in his survey posited that there exist two broad types of extrinsic incentives 

(financial and non- financial) that are most effective for managing performance behaviour at the 

individual level. Emmet et al., (2013), asserts that money remains the most significant motivational 

strategy. These scholars demonstrated the motivational power of money through the process of job 

choice. They explained that money has the potential to attract, retain and motivate individuals 

towards higher performance. Dessler, (2012), stated that many managers use money to reward or 

punish workers. This is done through the process of rewarding employees for higher productivity 

by instilling fear of loss of job (eg premature retirement due to poor performance). The desire to 

be promoted and earn enhanced pay may also motivate employees. Salary is an extensively 

researched extrinsic motivator. Recent studies of Zhang et al., (2018), resulted in considerable 

evidence that higher wages directly affect job performance. They also argue that in Heckhausen 

(2018) in his survey posited that there exist two broad types of extrinsic incentives (financial and 

non- financial) that are most effective for managing performance behaviour at the individual level. 

Emmet et al., (2013), asserts that money remains the most significant motivational strategy. These 

scholars demonstrated the motivational power of money through the process of job choice. They 

explained that money has the potential to attract, retain and motivate individuals towards higher 

performance. Dessler, (2012), stated that many managers use money to reward or punish workers. 

This is done through the process of rewarding employees for higher productivity by instilling fear 



 

  

27  

  

of loss of job (eg premature retirement due to poor performance). The desire to be promoted and 

earn enhanced pay may also motivate employees. Salary is an extensively researched extrinsic 

motivator. Recent studies of Zhang et al., (2018), resulted in considerable evidence that higher 

wages directly affect job performance. They also argue that in the case that labour turnover is 

costly for an organization because of severance, training and hiring costs), firms could pay higher 

wages to decrease quit rates and making savings on turnover costs.  

In contrast to the above view, some scholars in their criticism contend that the emphasis is too 

much on reward based on quantity of output rather than quality which cannot lead to quality service 

(Kerr et al, 2013). Kerr et al., (2013), observed that the problem with relying too much on money 

as motivator is that it can encourage employees to focus on whatever will earn an immediate 

incentive rather than on finding long-term solutions or creating new approaches. This view is 

upheld by Thibault et al., (2017), with the need for managers to be mindful of overreliance on 

money in motivation as this can be counterproductive.  

  

2.4.3 Classification of Motivation  

There are quite a number of debates surrounding the actual classification of motivation as scholars 

continue to grapple with the subject matter.  In most of the cases, two main groupings have been 

recognized:  Intrinsic and extrinsic with each of these having its own variants. Sprangler et al 2014; 

Rheinberg et al 2018) all lend credence to this proposition by including achievement motivation 

under intrinsic motivation.  



 

  

28  

  

Locke, (2015), in his construct of classification of motivation came up with three classifications 

namely; intrinsic motivation, extrinsic motivation and achievement motivation.  Each of these and 

the features associated are highlighted in the below:   

  

  

  

  

  

  



 

 

         Table 2.1: Summary of the Trichotomy of Motivation   

DESCRIPTION  INTRINSIC 

MOTIVATION  

ACHIEVEMENT 

MOTIVATION  

EXTRINSIC 

MOTIVATION  

Short definition  
Linking or wanting and 

activity for its own sake  

Recurrent concern for a 

standard of excellence  

Doing something in order to 

get some future value  

Core Aspect/Related 

goals  

Enjoyment and pleasure 

form the experience  Achievement : meeting a 

standard improvement, skill 

building  

Attainment of valued 

outcomes  

Locus of Incentive/  

Affective reaction  
Inside the activity, the 

pursuit of aciton, Happiness 

during the pursuit of action.  

In the improvement, in the 

challenge. Pride in achievment, 

success or progress.  

Outside the activity, in the 

consquences. Satisfaction with 

outcome  

Applications in 

organizations  
Reflect likes and dislikes.  

Affective task visualizaiton.   

Match task with interest.  

Clear performance standard. 

Give feedback. Encourage 

learning from mistakes  

Make goals meaningful.  Link 

goals to company vision.  

Recognize merits  

        Source: Locke, 2015 



 

30  

  

This study’s focus is mainly on intrinsic motivation and extrinsic motivation and therefore, 

inferences will reflect these.  

  

2.5 Theories of Motivation  

There is a general agreement among psychologists that with a few exceptions, which will be noted, 

all behaviors are motivated, people have reasons for doing the things they do and that behavior is 

oriented towards meeting certain goals and objectives (Seijts et al., 2013). That is why Freud and 

other psychologists like Taylor generally agreed that, an individual is motivated by the desire to 

satisfy a number of needs, some of which he is not consciously aware of (Seijts et al., 2013). 

Differences of opinions exist as to the nature and relative importance of these needs.  

  

2.5.1 Content Theories  

Proponents of the content theory of motivation postulates that motivation starts with unfulfilled 

need. Content theorists such as Maslow, (1943), and Herzberg et al. (1959), among others seek to 

determine how managers motivate their employees by studying their needs and assisting them 

appreciate the things and behaviour that satisfy them. In fact, the content theories assert that 

motivation is a phenomenon that enhances the performance level of an individual. Some of these 

theories are discussed in the following sessions:  

  

2.5.2 Maslow’s Theory of Motivation  

Maslow, (1954), came up with the theory of hierarchy of needs. This is based on clinical 

supervision and logic. In this theory of motivation, he stresses that individuals are motivated to 

satisfy several different kinds of needs, which are more pressing than others.  Maslow’s theory 



 

31  

  

states that if a number of features of a person’s needs are unsatisfied at any given time, satisfaction 

of the most current ones will be more pressing than that of others. So Maslow was on the idea that 

a satisfied need does not determine behavior but unsatisfied need determines behaviour 

(Norhayate, 2012). This implies that the health worker’s behavior in the hospital is a function of 

his needs. In other words, his needs influence his behavior in the workplace in no small measure.  

  

2.5.3 Herzberg’s Theory of Motivation  

Herzberg established what he called hygiene or maintenance factors and motivators.  According 

to him, there are certain extrinsic factors which by their presence do not increase the workers 

satisfaction on the job, but their absence may lead to job dissatisfaction and lower productivity 

among employees (Mohd et al., 2012).  Accordingly, Mohd et al., (2012), suggested that such 

extrinsic job conditions were environmental factors over which the employee has limited 

influence. They include payment, interpersonal relations, organizational policy and administration, 

supervision and working conditions. These are called hygiene factors or dissatisfiers. The 

significance of this factor is that, it does not only rely on extrinsic rewards for motivating 

employees for higher production but also incorporates in the job itself those ingredients that could 

help motivate employees.   

Though researchers support Herzberg, his work is not free of criticism. Critics questioned how he 

gathered his data. However, Herzberg’s theory is in many ways a gross over simplification as 

various aspects of the motivations theories clearly show in it (Njanjal et al.,  

2013).  

It has made a major contribution in focusing attention on jobs redesign for the purpose of making 

the work more intrinsically satisfying (Dessler, 2011).  



 

32  

  

Hence, Herzberg’s theories have been found to be applicable in the field of health in the following 

ways:  

Motivation is related to leadership for good leadership sets an example, provides guidance, 

encouragement and instructions. This can be one of the greatest motivational strategies of all health 

facilities.  

Another feature of motivation of workers is that if health workers are properly motivated, this can 

change an otherwise mediocre group into a highly productive team.  

Good motivation of health staff is definitely related to morale. In a large organization, high morale 

is difficult to attain and motivation of health care staff is a prime factor in achieving  

it.  

  

2.5.4 McGregor’s Theory of Motivation  

Another human relation theorist McGregor advanced the belief about human behavior that could 

be held by different managers. He sees two sets of assumption made by managers about their 

employees:   

The first view indicates that average human beings have an inherent dislike of work and will avoid 

it if possible. As a result of these human characteristics of dislike of work, most people must be 

coerced, controlled, directed and threatened with punishment to get them to put forth adequate 

effort towards the advancement of the organization objectives (Nguyen, 2019). The average human 

being prefers to be diverted, wishes to avoid responsibility, has relatively little ambition and wants 

security above all. The holders of this view believe that, motivation of workers can be attained 

through authority and fear and that, employees have to be closely watched if result must be 

obtained (Nyambegera et al, 2016). In summary, this x side of the theory emphasized control and 



 

33  

  

extrinsic rewards. On the other hand, the second assumption called theory y, sees man in a more 

favorable light. Here, workers under this concept of management possess potential that is generally 

untapped by most working environments. It has the following assumptions: The time spent on 

physical and mental efforts in work is as natural as play or rest. External controls and the threats 

of punishment are not the only means for bringing about effort towards organizational objectives 

(Guntert, 2015).  

People will exercise self-direction and self-control in the service of objective to which they are 

committed. Commitment to objectives is a function of the rewards associated with their 

achievement. The most important of such rewards is the satisfaction of ego and selfactualization 

towards organizational objectives (Heckhausen, 2018). An average human being learns under 

proper condition not only to accept but also to seek responsibility. The capacity to exercise a 

relatively high degree of imagination, ingenuity and creativity in the solution of organizational 

problems is wide and not narrowly distributed in the population (Armstrong, 2011).  

Under the conditions of modern industrial life, the intellectual potentialities of the average human 

beings are only partially utilized. This theory presents aspects of participation and concern for 

workers morale; encouraged managers to begin to delegate authority for making decisions; enrich 

or enlarge jobs by making them less exacting as the way to motivate employees to higher 

performance.  

In conclusion, this theory summarized the employee’s behavior using the two sides of its X and Y. 

As it was stated above, the x side of it emphasized control and extrinsic rewards they side of it 

emphasized the managerial concern for workers’ morale and encouraged managers to begin to 

delegate authority for making decisions; enrich or enlarge job by making them less repetitive as 

the ways to motivate employees to higher performance.  



 

34  

  

The implication of this theory is that health workers should always be able to effectively exercise 

control and proper management of the hospital while they take care of patients in various ways, 

considering individual differences and environmental conditions, among others which will 

enhance easier health care delivery (Ebuehi et al., 2011).  

  

2.5.5 Cognitive- Field Theory of Motivation  

This theory was popularized by Kurt Lewin. In an attempt to explain the theory, he proposed 

certain motivational constructs. These are:  

Tension: In an organism, tension is created by disequilibrium within the organism, which the 

organism wants to release through activities. The activities which help in releasing tension have 

position valence in an organism and valence directs behavior. Tension continues till the organism 

attains its goals (Kerr et al. 2013).  

Need: Two types of need were proposed here and these are genuine need and quasi need. Genuine 

needs can come from the physiological conditions of the organism such as hunger, thirst, shelter 

etc. Quasi need is tension that arises from intentions, acts of will and other arbitrary commitments 

of the individual. Every organism has a characteristic structure of needs which create tension 

thereby making the organism to be activated (Hofer et al., 2010). Force and Valence: The 

desirability of an activity is called valence and the tendency to engage in the act is called force. 

Valence influences choice while force is more useful for speed or persistence of behavior.   

Need gives rise to force signifying a valence activity and the organism having no need of the 

environment, registers no valence and no force is also generated.  

In summary, the cognitive field theory of motivation is a direct function of the combinations of 

tension, need, force and valence.  



 

35  

  

This theory is applicable in the field of health and also to what happens in the life of a health 

worker. For instance, like one of the motivational constructs “Needs” such as hunger, thirsty, 

shelter etc. the worker that is characterized with these problems will not perform well in the 

hospital, and thereby affecting the overall service delivery.   

However, when health workers are motivated such as payment of housing and transport 

allowances, their salaries are paid regularly, when they get car loans and maintenance allowances, 

these will enhance positive attitude towards their tasks and as such ensure high performance (Adzei 

et al., 2012).  

 

Process Theories  

Process theorists try to interrogate the reasons for which people pursue certain goals. They 

therefore, provide descriptions and analysis of how behaviour is energized, directed, sustained and 

or stopped (Banmann et al., 2011). This body of knowledge is built on the scientific management 

model developed by Frederick Taylor in 1911. The process theory is also based on the assumption 

that a person will be motivated to work if rewards and penalties are tied directly to his performance.  

It is also anchored on the principle of reinforcement which states that people can be conditioned 

to act in certain ways if they are rewarded for behaving as input (Bock, 2015). Some process 

theories are expectancy, goal and equity as discussed below:  

  

Victor Vroom’s Theory of Motivation  

Victor Vroom,(1964), in his own contributions advanced the expectancy valence theory. He stated 

that if the individual worker believes that working hard will lead to salary increase, he will 

intensify his effort and work hard. The theory recognizes that people act only when they have a 

reasonable expectation that their actions will lead to a desired goal. Victor Vroom called this: 



 

36  

  

“Expectancy theory” which places emphasis on performance, noting that, there must be a clearly 

recognized goal and relationship between performance and outcome. Motivation is a function of 

the expectancy of attaining a certain outcome in performing a certain act multiplied by the value 

of the outcome for the performance.  

M (f) = ExV 

Where M = Motivation  

E = Expectancy  

Expectancy theory has two outcomes; first, outcomes that are highly valued, and have high 

expectations of being realized, will direct a person to make a greater effort. Secondly, outcomes 

with high expectations, which are less highly valued or even dislike will reduce the effort expected. 

The significance of this theory is that an administration should take cognizance of the relationship 

of the first and second outcomes and use them to motivate staff  

(Guntert, 2015).  

Alderfer’s Existence, Relatedness and Growth (ERG) Theory of Motivation Clayton P. 

Alderfer distinguishes three categories of human needs that influence workers’ behavior; 

Existence, Relatedness and Growth as follows:  

Existence needs: These needs are basic material needs for one’s existence or survival.  

Psychological and safety needs include hunger, thirst and sex.  

Relatedness needs: These are needs that desire to establish, maintain and develop interpersonal 

relations such as involvement with family friends, co-workers and employers.  

Growth needs: These are needs for the fulfillment of one’s development as well as internal esteem 

and self- actualization (desires to be creative, productive and to complete meaningful task) 

(Masunda, 2015).  



 

37  

  

In addition, the ERG model acknowledges that if a higher need remains unfulfilled, the person may 

regress to lower level needs that appear easier to satisfy. This is known as the  

Frustration Regression Principle and vice versa referred to as Satisfaction Progression.  

Implications of Alderfer’s ERG Theory  

Organizations must appreciate that an employee has several requirements/needs that must be 

satisfied at the same time. According to the ERG theory, if the organization focuses exclusively 

on one requirement at a time, this may not successfully motivate the employee. The frustration-

regression aspect of the theory has an auxiliary influence on workplace motivation. For instance, 

if an employee is not provided with development or learning opportunities in an organization, the 

employee may revert to meeting the relatedness need such as socializing needs. However, if the 

environment or circumstances do not permit, the employee may revert to the need for monetary 

rewards to satisfy those socializing needs. The earlier the organization comprehends and 

determines this, the more steps it will take to fulfill those needs which are unfulfilled until such 

time that the employee can pursue growth  

(Kim, 2017).  

Criticism of Alderfer’s ERG Theory  

In Clayton Alderfer’s ERG theory, the fact that the needs are not strictly demarcated goes against 

the theory. This is one of the important reasons for lack of popularity for Alderfer’s theory. The 

term ‘relatedness’ used in the theory is particularly confusing; and like other content theories, it 

fails to contribute effectively to human resource management  

(Armstrong, 2011).  



 

38  

  

Adam’s Equity Theory of Motivation  

Equity theory suggests that employees compare their pay with what other employees get as their 

pay. Satisfaction with pay is connected with the pay employees receive from their organizations 

compared with the amount received by others. The theory also indicates that pay satisfaction 

depends on the difference between the actual pay received by employees and what they feel they 

should have received (Ngui et al., 2014).  

According to Ngui et al., (2014), employees who perceive that they have been underrewarded or 

over- rewarded, restore equity by changing their own inputs, or choosing a different person for 

comparison, or ultimately quitting the job. Equity theory is vital because it highlights the fact that 

employees are not only concerned with the absolute amount of rewards they receive, but with the 

rewards they receive relative to the rewards of others. It therefore, recommends that managers 

should not underpay or overpay some of their employees, but ensure that every employee is treated 

fairly.  

Implications of Adam’s Equity Theory   

Employees compare themselves with other employees who do not put in the inputs that are equal 

to the outputs they receive. They tend to compare themselves with other employees to find out if 

they are being treated fairly. Employees may seek the balance between their inputs and outputs 

and it is not always possible to give them correct balance. However, to give a fair outcome to all 

employees, the managers should try to understand the employees better (Armstrong, 2011). 

Managers should therefore, know what the employee are aiming for and try to give them the best 

possible reward they expect.  



 

39  

  

Criticism of Adam’s Equity Theory  

Traditional research on equity theory only measures whether the work effort increases or decreases 

but fails to test whether the magnitudes of these increases or decreases are in line with what equity 

theory will predict. This theory provides weak support for the variety of alternative models that 

are able to make the same predictions of equity (Ngui et al, 2014).  

  

2.6 Performance and Performance Measurement  

The measurement of an employee’s performance allows for rational administrative decisions at the 

individual employee level. It also provides for the raw data for the evaluation of the effectiveness 

of such personnel - system components and processes as recruiting policies, training programmes, 

selections rules promotion strategies, and reward allocations (Brown  

et al., 2010).     

Gupta et al., (2013), looks at performance measurement as a process of quantifying the efficiency 

and effectiveness of action. They further added that the activities required to measure performance 

include three elements as follows: a) individual measures that qualify the efficiency and 

effectiveness of actions. b) a set of measurements that are combined to assess the performance of 

an organization as a whole. c) a supporting infrastructure that enables data to be acquired, collated, 

sorted, analyzed, interpreted and disseminated. Performance management helps to rate the 

performance of the employee and evaluate their contributions towards organization achievement. 

Where the process is formally and properly structured, it helps the employees to clearly understand 

their roles and responsibilities and give directions to the organizational goals and also review their 

performance. Clearly, the modern paradigm shift is that performance management takes into 



 

40  

  

account the performance of the employees and focuses on the improvement of their future 

performance (Ngui et al., 2014).  

Performance management is the continuous process of identifying, measuring, and developing the 

individuals and teams; aligning their performance with the organization’s goals (Dessler, 2011). 

Using measurement to manage performance enables the manager or supervisor to be fair and 

balanced in the assessment process. This is very important to assess performance because no two 

people are the same when it comes to individual capabilities, competencies and execution of a 

given task.  

Performance management is often related to Performance-Related Pay (PRP), although by no 

means all organizations claim to use performance management and have PRP. Nevertheless, PRP 

is an important element in many performance schemes because it is believed to motivate; it is said 

to deliver the message that performance and competencies are important, and it is thought to be 

fair to reward people according to their performance, contribution or competence (Imre et al., 

2014). Closely linked to performance and measurement issues are the need for target or objective 

setting in most organization including Ghana Health Service where managers are enjoined to sign 

performance agreements with their supervisors to deliver on some set objectives during the year 

under review (Ghana Health Service, 2014).  

  

2.7 Relationship between Motivation and Performance and Delivery of Quality Health  

Care Services:  At the centre of health care delivery is adequate motivation of health workers  

(Adzei et al., 2012). Motivation results in better performance as well as knowing and doing the 

right thing (Kim, 2017). Ideally every employee will put up better performance if the incentive 

packages are rewarding and in line with the capacity to meet needs of the individual.  



 

41  

  

In this regard, while economic factors play a part in motivating of health workers (World Health 

Organization, 2010), other factors are equally crucial. For instance, many health workers in Ghana 

often leave the sector to seek greener pastures elsewhere (Adzei et al., 2012). These movements 

of health workers in Ghana inevitably leave the sector poorer in terms of quality health care with 

net effect being translated into an area like poor child health indicators. Research has highlighted 

the fact that in every organization, employee motivation is necessary because it leads to service 

quality delivery (Nyambegera, 2016).  

Going by the definitions of motivation, one can simply conclude that efficiency, good performance 

and high productivity are direct function of adequate motivation on the part of workers in an 

organization. According to Mullei et al., (2010), when workers are properly motivated, leading to 

efficiency, good performance and high productivity, the implication of this is sudden and sustained 

rise in national growth and development and invariably the general improvement in the welfare of 

the citizens.  

Thibault et al., (2017), in their view on the link between motivation and performance allude to 

Elton Mayor’s Studies on the work habits of the employees at the Hawthorne Western Plant where 

it was discovered that efficiency in the production process and increased output were realized when 

employees were motivated and the reverse being the case when they were not motivated.  

In the field of health, the role of motivation cannot be over emphasized. That is to say that 

motivation plays a very significant role in attaining the overall health aims and objectives through 

the service delivery process (Ebuehi et al., 2011).   

CHAPTER THREE  

METHODOLOGY  



 

42  

  

3.1 Introduction  

The aim of this chapter is to explain methods used in carrying out this research, how the research 

was designed and reasons for the choice of methodology used.  The chapter comprises the research 

design, data collection techniques, population of study, study variables, sampling, data handling 

and data analysis.   

3.2 Research Methods and Designs  

This research work was quantitative. It sought to determine the role of motivation in impacting 

performance or service delivery of health workers. Given the nature of the research which involved 

variables that were more or less cause and effect and were very closely related, it became necessary 

to be more quantitative than qualitative.   

In addition, a case study approach was employed. Case studies are a useful way to explore, examine 

or bring to light variables, phenomena, processes and relationships that have not been thoroughly 

researched and as such deserve more intensive investigation (Robert, 2010). The primary aim of a 

case study is to help the researchers determine the factors, and the relationships among the factors 

that have resulted in the current behaviours or status of the subject of the study. The essence of 

using a case study design was to gain insight into the state of motivation at the Ho Municipal 

Hospital.    

Cross-sectional studies are carried out at one time point or over a short period (Levin, 2006).  

In this way cross-sectional studies provide a ‘snapshot’ of the outcome and the characteristics 

associated with it, at a specific point in time. A cross-sectional study design is used when the 

purpose of the study is descriptive, often in the form of a survey. Usually there is no hypothesis as 

such, but the aim is to describe a population or a subgroup within the population with respect to 



 

43  

  

an outcome and a set of risk factors. Thus, a cross-study research study approach was also 

employed.  

3.3 Data Collection Techniques and Tools  

In this research, a questionnaire developed by Bennet et al. (2001) and adopted by Mbindyo et al. 

(2009), to measure the motivation of health personnel at district hospitals in Kenya was the main 

instrument reviewed and employed for data collection. The questionnaire was provided to gather 

the information from the staff of the hospital. Instruments on the likert scale were designed for the 

respondents. The responses on the Likert scale consisted of: 1 = strongly disagree 2 = disagree 3 

= fairly agree 4 -= agree 5 = strongly agree. To make analysis easier, the closed ended questions 

was provided with alternatives and clear instructions to respondents. The open-ended questions 

were intended to give respondents the latitude of freedom to express their views in an 

unconstrained manner. The questionnaire was divided into various sections to capture the critical 

areas spelt out in the objectives for the study  

3.4 Study Population  

The population of this study comprised employees of the Municipal Hospital in Ho Municipality. 

The population was heterogeneous as the hospital had staff with different educational 

backgrounds, social status as well as duration of service. The hospital has a population of two 

hundred and ninety- six (296) staff. However, the target population for this study consisted of two 

hundred and nine (209) made up of clinicians including, nurses, doctors, radiographers, biomedical 

scientists, physician assistants, dieticians, and pharmacists.  



 

44  

  

3.4.1 Inclusion Criteria  

These included all full time employed clinical staff within, at least six months work experience. 

The rationale behind these inclusion criteria was to obtain responses from health workers who 

were more experienced and well informed about their environment and voluntarily wanted to be 

part of the study.  

3.4.2 Exclusion Criteria  

All categories of staff who were officially on leave or absent because of illness and all categories 

of supporting staff who do not directly render care to patients at the hospital were excluded.  

3.5 Study Variables  

The two main variables in question under this research are motivation and performance (service 

delivery). The former, being an independent variable while the latter, dependent.  As noted in the 

previous chapter motivation is a concept that energizes an individual or a group of individuals to 

act in a certain way. These can be intrinsically and extrinsically based. Thus, these forms of 

motivation were demonstrated in this study to impact performance (service delivery) in the health 

sector.   

3.6 Sampling   

In this research, purposeful sampling method was employed. The total population of staff at the 

hospital is 296, however the sample used was 209 constituting all the clinical staff. One hundred 

and ninety-four (194) out of the 209 responded to the questionnaire, made up of 93%, and therefore 

was used for this study. Normally, the purposeful sampling method is used when the researcher 

wants to focus on a limited number of informants; who are selected strategically so that their in-



 

45  

  

depth information would give optimal insight into an issue (Roberts, 2010).  As a result, the 

research adopted an example of purposeful sampling referred to as critical case sampling, where 

those who could make the difference with respect to their involvement were approached. The 15 

clinicians who could not respond to the questionnaire were excluded due to ill-health, annual leave 

and further studies. The study focus was aimed at all the clinicians whose number is 209. As a 

result, it was found unnecessary to engage in sample size determination.   

3.7 Pre-Testing  

A questionnaire was developed to collect data from the sample frame.  The questions were mainly 

ordered on a likert scale. The questionnaire was divided into various sections to capture the critical 

areas spelt out in the objectives of the study. For the purpose of this study, both the face and content 

validity were ensured. To ensure validity of the instruments, the initial drafts of the instruments 

were scrutinized by three experts in questionnaire and content construction who were required to 

check for all flaws in the instruments. The content validity of the instruments was also enhanced 

by the suggestions from the experts. Based on the suggestions and comments, the necessary 

corrections were made and this enhanced a thorough validation in order to ensure that the 

instruments actually measured what it was intended to measure in relation to the research 

questions. The final version of the instruments was trial tested on a sample of twenty staff members 

who were not part of the study sample, precisely from Peki Government Hospital, Peki. The issue 

of reliability was also addressed. To prevent unreliability, the researcher, first of all ensured that 

the wording of the questions were not ambiguous; ensured that the questions were administered 

from the same setting; ensured that all respondents were asked if they were ready and willing to 

answer the questions.  

  



 

46  

  

3.8 Data Handling  

 First, a letter was sent to the Hospital Medical Superintendent for permission to be granted in 

order to administer questionnaire on the premises. After the design and pre- testing of the data 

collection instruments, the researcher administered it personally. This was to ensure that the 

questionnaires reached the target group and also helped to explain, if or when problems arose, to 

the respondents. This helped also to show how important the findings were to the researcher and 

assured the respondents that their views were really needed and would be treated with importance 

and confidentiality. The self-administration helped the researcher to know and observed the 

respondents on how they accepted the questionnaires and whether their responses were valid or 

reliable.  

A total of two hundred and nine (209) questionnaires were distributed to the respondents. After a 

day or two the researchers went back and collected the answered questionnaires because the 

respondents may forget to fill in the questionnaire or misplace them entirely.   

  

3.9 Data Analysis   

The data from the questionnaires was coded for easy entry into the Stata 14 software. Frequency 

distribution tables were used to depict results obtained from the respondents on the factors that 

influence motivation among health workers at the hospital, the influence of intrinsic motivation, 

the influence of extrinsic motivation on employees’ performance, and the link between motivation 

and performance. Inferences and calculations were made from the measures and compared with 

the existing literature to arrive at the conclusion for the study.   

  



 

47  

  

3.10 Ethical Considerations  

As with all research projects, this study observed all protocols regarding ethical considerations. 

Every effort was made in ensuring that the work went through all academic rigors deserving of 

scholarship. In this direction, the highest levels of honesty, privacy, confidentiality, secrecy and 

disclosure was employed to protect respondents and also in the entire work. The Ensign College 

of Public Health’s requirements of ethics in research were adhered to and therefore informed the 

way respondents consent was sought for this work.  

  

3.12 Assumptions  

This study has a number of assumptions to enhance its success as stated: the assumptions that all 

the respondents had a considerable level of education which promoted their understanding of the 

content of the instruments administered. It was also assumed that the subject matter of motivation 

is quite familiar to the health workers who are at the centre of this research.   

  

  

  

  

 CHAPTER FOUR  

RESULTS  



 

48  

  

4.0 Introduction  

This chapter presents results on the analysis of the study. It also contains description of data 

obtained from the instrument and their discussions as well as tables and charts of data obtained.   

4.1 Method  

 Questionnaires were solicited from two hundred and nine (209) employees of Ho Municipal 

Hospital. Employees were told that their participation would help provide a better understanding 

of the unique needs of stress on job performance in health service delivery. They were also told 

that their responses would be completely anonymous. They completed the twenty-four (24) 

question instrument and submitted their responses. Of the two hundred and nine (209) employees, 

one hundred and ninety-four (194) completed the questionnaire with fifteen (15) failing to respond 

for various reasons cited in section 3.6 of the previous chapter. The final number of questionnaires 

used in the analysis was one hundred and ninetyfour (194) which represented 93% which is 

positive response.   



 

49 

 

4.2 Demographic Data  

Table 4.1: Age Breakdown of Respondents  

  Doctors  Nurses  Midwives  Pharmacists  Biomedical  

Scientists  

 Total  

Age  %  Age  %  Age  %  Age  %  Age  %  Age  %  

Below 20  0  0.00  1  0.99  1  1.49  0  0.00  0  0.00  2  100.00  

20-29  0  0.00  45  44.55  28  41.79  2  2.98  9  60.00  84  100.00  

30-39  3  60.00  45  44.55  33  49.25  2  2.98  6  40.00  89  100.00  

40-49  2  40.00  10  9.90  5  7.46  2  2.98  0  0.00  19  100.00  

Total     100.00    99.99    99.99    8.94    100.00    100.00  

Source: Field Survey  May, 2020



 

50 

 

Among the age groups, below 20, nurses and midwives represented 0.99% percent and 1.49% 

percent respectively, then between 20-29 nurses, midwives, pharmacists and biomedical scientists 

had 44.55% percent, 41.79% percent, 2.98% percent 60 percent respectively.   

Between the ages of 30-39; doctors, nurses, midwives, pharmacists and biomedical scientists, 

scored the highest percentages of the following: 60%, 44.45%, 49.25%, 2.98% and 40% 

respectively. Doctors, nurses, midwives, pharmacists and biomedical scientists with the age 

group of 40-49 had the lowest percentages. These were 40%, 9.98%, 7.46%, 2.98%, 0.00% 

respectively.   

Table 4.2:  Results of the Highest Qualifications of Respondents  

Highest Qualification  Frequency  Percentage  

Certificate   25  12.89%  

Diploma  79  40.72%  

Bachelor’s disagreed  79  40.72%  

Post Graduate   11  5.67%  

Total   194  100  

            Source: Field Survey, May, 2020  

The researcher wanted to know the highest educational background of respondents. The results 

showed diploma and bachelor degree holders had the same percentage of 40.72%, certificates 

holders had 12.89% and post graduate or second degree had 5.65%  

  



 

51  

  

Table 4.3: Results showing how long respondents have been working in the facility  

  <1yr  1-4yrs  5-9yrs  10-14yrs  15yrs  Total  

Doctors   0(0.00%)   2(2.22%)  2(4.65%)  1(3.57%)  0(0.00%)  5(2.58%)  

Nurses   15(51.72%)  43(47.78%)  23(53.49%)  17(66.71%)  3(75.00%)  101(52.06%)  

Midwives   11(37.93%)  33(36.67%)  13(30.23%)  9(32.14%)  1(25.00%)  67(34.54%)  

Pharmacists  1(3.45%)  1(1.11%)  3(6.98%)  1(3.57%)  9(0.00%)  6(3.09%)  

Biomedical  

Scientists  

2(6.90%)  11(12.22%)  2(4.65%)  0(0.00%)  0(0.00%)  15(7.73%)   

Total   29(100.00)  90(100.00)  43(100.00)  28(100.00)  4(100.00)  194(100.00)  

Source: Field Survey, May 2020  

The researcher wanted to find out the number of years the categories of respondent worked in 

the Ho Municipal Hospital. Of the respondents who worked for less than one year, nurses were 

highest, 51.72%. Biomedical scientists represented 6.90% whilst pharmacist, constituted 3.45% 

as the lowest. Those who worked for between 1 and 4 years, 43 nurses 47.78% represented the 

highest. This is followed by midwives, 33 (36.67%), biomedical scientists were 11(12.22%) and 

the lowest being pharmacists, 1(1.11%). Respondents who have been in the facility for between 

5 and 9 years were represented as follow: nurses 23 (53.49%) as highest, 13 midwives constituted 

30.23%) and pharmacists, 3 (6.98%). Both doctors and biomedical scientists had same number 

of respondents, 2 each representing,  

4.65% For those who worked in the hospital for between 10 and 14 years, nurses recorded  



 

52  

  

66.71% midwives, 32.14% while pharmacists and doctors had same percentage of 3.57% There 

was no biological scientist in this category. Respondents with up to 15 years and above stay in 

the hospital showed nurses, 75% and midwives 25% respectively.   

Table 4.4: Working with little or no supervision motivates me to improve performance   

  

Strongly 

Disagree  

Disagree  

Fairly 

Agreed  

Agreed  

Strongly 

Agreed  

Total  

Doctors  1(4.76%)  0(0.00%)  1(3.57%)  1(1.09%)  1(3.57%)  4(2.06%)  

Nurses  12(52.17%)  12(52.17%  15(53.57%)  45(48.38%)  17(60.71%)  101(52.06%)  

Midwives  8(34.78%)  9(39.13%)  8(28.57%)  36(38.70%)  6(21.42%)  67(34.53%)  

Pharmacists  0(0.00%  0(0.00%)  1(3.57%)  2(2.15%)  3(10.71%)  6(3.09%)  

Biomedical  

Scientists  

0(0.00%  2(8.69%  3(10.71%)  9(9.67%)  1(3.57%)  15(7.73%)  

Total  21(100%)  23(100%)  28(100%)  93(100%)  28(100%)  194(100%)  

Source: Field Survey, May, 2020  

The table shows that the group with the highest response rate of strongly disagree was nurses 

with the percentage of 52.17% disagree, 53.57% fairly agreed, 48.39% agreed to working 

without supervision or little supervision. Finally, 60.17% of nurses strongly agreed to the 

statement.  



 

53  

  

Overwhelming majority of doctors fairly agreed, 3.57%, agreed, 1.08% and strongly agreed, 

3.57%. 4.76% of doctors however, strongly disagreed with the statement. In the case of 

midwives, 38.09%, strongly disagreed, and 39.13% disagreed. 28.57% fairly agreed,  

38.71%, agreed and 21.42%, strongly agreed. Generally, all the pharmacists agree to working with 

little or no supervision thus: fairly agreed, 3.57%, agreed, 2.15% and strongly agreed, 10.17%. 

Biomedical scientists recorded 8.70%, for disagreed, and fairly agreed was  

10.17%, 9.68% and 3.57%, went for agree and strongly agree respectively.  

  

Table 4.5: My achievement and personal satisfaction in my work enhance(s) my 

performance   

  Strongly 

Disagreed  

Disagreed  Fairly 

Agreed  

Agree  Strongly 

Agreed  

Total  

Doctors  0(0.00%)  1(11.11%)  0(0.00%)  2(2.38%)  2(3.17%)  5(2.58%)  

Nurses  6(42.86%)  6(66.67%)  12(50.00%)  41(48.81%)  36(57.14%)  101(52.06%)  

Midwives  6(42.87%)  25(22.22)  9(37.56%)  30(35.71%)  20(31.75%)  67(34.54%)  

Pharmacists  1(7.14%)  0(0.00%)  2(8.33%)  2(10.71%)  3(4.17%)  6(3.09%)  

Biomedical  

Scientists  

1(7.14%)  0(0.00%)  2(8.33%)  9(10.71%)  3(4.76%)  15(7.73%)  

Total  14(100%)  9(100%)  24(100%  84(100)  43(100%)  194(100%)  

Pearson chi2(16) – 9,2819    Pr -0.901  

The researcher delved into the respondents to know whether their achievement and job 

satisfaction enhance their performance and the highest strongly disagreed groups fell on nurses 



 

54  

  

of 42.86% and midwives 42.87% followed by strongly agreed 57.14% and 31.75% respectively. 

Biomedical scientists largely responded thus: fairly agree, 8.33%, agree,  

10.71% and strongly agree, 7.73%. Majority of doctors’ and pharmacists’ responses ranged from 

fairly agree to strongly agree.  

 Table 4.6: Continuous education through training and development programs will help 

improve my skills and influence(s) performance   

  Strongly 

Disagreed  

Disagree  Fairly 

Agreed  

Agreed  Strongly  

Agreed  

Total  

Doctors   1  

7.14  

1  

20.00  

0  

0.00  

0  

0.00  

3  

3.41  

5  

2.58  

Nurses   8  

57.14  

3  

60.00  

12  

52.17  

31  

48.44  

47  

53.41  

101  

52.06  

Midwife   4  

28.57  

1  

20.00  

8  

34.78  

25  

39.06  

29  

32.95  

67  

34.54  

Pharmacist  0  

0.00  

0  

0.00  

1  

4.35  

3  

4.69  

2  

2.27  

6  

3.09  

Biomedical  

Scientist  

1  

7.14  

0  

0.00  

2  

8.70  

5  

7.81  

7  

7.95  

15  

7.73  

Total   

  

14  

100.00  

5 100.00  23  

100.00  

64  

100.00  

88  

100.00  

194  

100.00  

Source: Field Survey, May, 2020  

The researcher sought to know whether training on the job and continuous education helped to 

influence their skills of job performance. Strongly disagreed was 57.14% for nurses and 28.57% 

for midwives. The group which strongly agreed was nurses and midwives 53.41% and 32.95% 

respectively. Most of the doctors strongly agree, 3,41%, same with pharmacists and biomedical 

scientists who mostly agree with the statement.  



 

55  

  

Table 4.7: Job security helps to enhance my performance   

  Strongly 

disagreed  

Disagreed  Fairly 

Agreed  

Agreed  Strongly  

Agreed  

Total  

Doctor   0  

0.00  

1  

16.67  

0  

0.00  

1  

1.54  

3  

4.23  

5  

2.58  

Nurse   14  

70.00  

4  

66.67  

19  

59.38  

37  

56.92  

27  

38.03  

101  

52.06  

Midwives  6  

30.00  

1  

16.67  

10  

31.25  

17  

26.15  

33  

46.48  

67  

34.54  

Pharmacist   0  

0.00  

0  

0.00  

0  

0.00  

5  

7.69  

1  

1.41  

6  

3.09  

Biomedical  

Scientist   

0  

0.00  

0  

0.00  

3  

9.38  

5  

7.69  

7  

9.86  

15  

7.73  

Total   20  

100.00  

6 100.00  32  

100.00  

65  

100.00  

71  

100.00  

194  

100.00  

Pearson chi2(16) – 26,2310      Pr = 0.051  

The study wanted to find out if job security also enhanced work performance. Based on these, 

the result of strongly disagreed for nurses was 70% and midwives, 30%. Looking at it on the 

other side with strongly agreed responses, nurses recorded 38.03% and midwives were 46.48%. 

Doctors, pharmacists and biomedical scientists were generally for either agree or strongly agree 

in their responses.  

  

 

  



 

56  

  

Table 4.8: Good interpersonal relationship with coworkers enhance work performance   

  Strongly 

disagreed  

Disagreed  Fairly 

agree  

Agreedd  Strongly 

agreed  

Total  

Doctors   0  

0.00  

0  

0.00  

0  

0.00  

1  

1.12  

4  

5.00  

5  

2.58  

Nurses   0  

0.00  

0  

0.00  

8  

38.10  

51  

57.30  

42  

52.05  

101  

52.06  

Midwives   2 100.00  2 100.00  11  

52.38  

28  

31.46  

24  

30.00  

67  

34.54  

Pharmacists   0  

0.00  

0  

0.00  

2  

9.52  

2  

2.25  

2  

2.05  

6  

3.09  

Biomedical  

Scientists   

0  

0.00  

0  

0.00  

0  

0.00  

7  

7.86  

8  

10.00  

15  

7.73  

Total   2 100.00  2 100.00  21  

100.00  

89  

100.00  

80  

100.00  

194  

100.00  

Pearson chi2(16)  = 19,8539   Pr = 0,227  

The researcher was inquisitive to know how interpersonal relationship would enhance work 

performance and it was revealed that 52.05% of nurses stated that they strongly agree it 

encouraged them to perform well.  Respondents in doctors, pharmacists and biomedical scientists 

categories unanimously responded under fairly agree, agree and strongly agree. For midwives, 

52,38% fairly agree, being the highest in their category,  

  

 

 

 



 

57  

  

Table 4.9: Responsive/friendly services offered by workers in this facility enhance client’s 

satisfaction and quality of care delivery in the hospital   

  Strongly 

disagreed  

Disagreed  Fairly 

agreed  

Agreed  Strongly 

agreed  

Total  

Doctors   0  

0.00  

0  

0.00  

0  

0.00  

3  

4.00  

2  

2.82  

5  

2.58  

Nurses  4  

44.44  

2  

33.33  

12  

36.36  

43  

57.33  

40  

56.34  

101  

52.06  

Midwives   2  

22.22  

4  

66.67  

13  

39.39  

25  

33.33  

23  

32.39  

67  

34.54  

Pharmacists   1  

11.11  

0  

0.00  

3  

9.09  

1  

1.33  

1  

1.41  

6  

3.09  

Biomedical  

Scientists   

2  

22.22  

0  

0.00  

5  

15.15  

3  

4.00  

5  

7.04  

15  

7.73  

Total   9 100.00  6 

100.00  

33  

100.00  

75  

100.00  

71  

100.00  

194  

100.00  

Pearson chi2(16) = 21.0475    Pr = 0.177  

The table depicts that nurses were in agreement with 57.33%, those who strongly agree recorded, 

56.34%. They were also the highest to also disagree with 44.44%. Midwives had the highest 

percentage of 66.67% as they disagree. The answers of the biomedical scientists were mostly in 

agreement: fairly agree, 15.15%, 4.00% for agree and 7.04% in strongly disagree. Doctors and 

pharmacists in general terms agree to the statement.  

  

 

  



 

58  

  

Table 4.10: Availability of adequate numbers of health workers at the facility to deliver the 

service improve quality of health care delivery   

  Strongly 

disagreed  

Disagreed  Fairly 

agreed  

Agreed  Strongly 

agreed  

Total  

Doctors  0  

0.00  

0  

0.00  

0  

0.00  

1  

1.28  

4  

5.26  

5  

2.58  

Nurses  5  

71.42  

5  

71.42  

10  

38.46  

44  

56.41  

37  

48.68  

101  

52.06  

Midwives  1  

14.29  

2  

28.57  

12  

46.15  

28  

35.90  

24  

31.54  

67  

34.54  

Pharmacists  0  

0.00  

0  

0.00  

0  

0.00  

1  

1.24  

5  

4.56  

6  

3.09  

Biomedical  

Scientists  

1  

14.29  

0  

0.00  

4  

15.34  

4  

5.13  

4  

7.89  

16  

7.73  

Total  7 100.00  7 

100.00  

26  

100.00  

78  

100.00  

76  

100.00  

194  

100.00  

Pearson chi2(16)  16.8381  Pr = 0.396  

The nurses scored highly,71.42% in each case in respect of strongly disagree and disagree 

respectively. 46.15% of midwives fairly agree to the statement. Majority of the doctors, 4 

(5.26%) responded, strongly agree. The pharmacists in majority also strongly agree 5 (4.56%). 

Biomedical scientists answered as: strongly agree, 14.29%, fairly agree, 15.34%,  

5.13% and strongly agree with 7.89%.  

  

 

  



 

59  

  

Table 4.11: My knowledge and skills help to improve safety of patients and influence 

quality of health care delivery   

  Strongly 

disagreed  

Disagreed  Fairly 

agreed  

Agreed  Strongly 

agreed  

Total  

Doctor   0  

0.00  

0  

0.00  

2  

6.90  

3  

4.17  

0  

0.00  

5  

2.58  

Nurse   2  

40.00  

6  

54.55  

17  

58.62  

31  

43.06  

45  

58.44  

101  

52.06  

Midwife   3  

60.00  

4  

36.36  

7  

24.14  

28  

38.89  

25  

32.47  

67  

34.54  

Pharmacist   0  

0.00  

1  

9.09  

1  

3.45  

1  

1.39  

3  

3.90  

6  

3.09  

Biomedical  

Scientist   

0  

0.00  

0  

0.00  

2  

6.90  

9  

12.50  

4  

4.19  

15  

7.73  

Total   5 100.00  11  

100.00  

29  

100.00  

72  

100.00  

77  

100.00  

194  

100.00  

Pearson chi2(16)   = 15.9695  Pr = 0.455  

The table shows that all the five doctors sampled largely agreeing to the statement, same with all 

the biomedical scientists. One pharmacist in each case responded disagree, fairly agree and 

agree. Three (3) pharmacists, however strongly agree. 54.55% of nurses disagree whilst 58.44% 

recorded strongly agree. In the case of midwives, 60.00% strongly disagree,  

36.36% disagree and 38.89% responding, agree.  

  

  



 

60  

  

Table 4.12: Incentive package at the Ho Municipal Hospital helps me to improve my 

performance   

  

Strongly 

Disagreed  

Disagreed  

Fairly 

Agreed  

Agreed  

Strongly  

Agreed  

Total  

Doctors   0  

0.00  

1  

4.76  

1  

4.35  

3  

3.61  

0  

0.00  

5  

2.58  

Nurses   
15 42.86%  14 66.67%  

12 

52.17%  

43 

51.81%  

17 

53.13%  

101  

52.06%  

Midwives   
13 37.14%  4 19.05%  7 30.43%  

30 

36.14%  

13 

40.63%  

67 

34.54%  

Pharmacists  

2 5.71%  2 9.52%  0 0.00%  5 6.02%  2 2.41%  6 3.09%  

Biomedical  

Scientists  

5 14.29%  0 0.00%  3 13.04%  5 6.02%  2 6.25%  15 7.73%  

Total   35  

100.00  

21  

100.00  

23  

100.00  

83  

100.00  

32  

100.00  

194  

100.00  

Pearson chi2(16) – 16.4485     Pr – 0.422  

The researcher wanted to know if any kind of motivation or incentive contributed towards the 

performance of respondents in the hospital. Nurses emerged with the highest percentage of 

42.86% for strongly disagree. The same category of nurses 53.13% strongly agreed that 

incentives boosted their performance. Midwives scored 40.63% under strongly agree.  

14.29% of biomedical scientists, being the highest in that category strongly disagree. One (1) 

doctor disagree while the rest of them either fairly agree or agree.  



 

61  

  

  

Table 4.13: Availability of materials and equipment for my work, including safe work 

environment help to improve my work  

  Strongly 

disagreed  

Disagreed  Fairly 

agreed  

Agreed  Strongly 

agreed  

Total  

Doctors  0  

0.00  

0  

0.00  

1  

4.17  

0  

0.00  

4  

5.19  

5  

2.58  

Nurses  6  

50.00  

7  

63.64  

12  

50.00  

39  

55.71  

37  

48.05  

101  

52.06  

Midwives  3  

25.00  

3  

27.27  

10  

41.67  

22  

31.43  

29  

37.66  

67  

34.54  

Pharmacists  1  

8.33  

1  

9.05  

1  

4.17  

2  

2.86  

1  

1.30  

6  

3.09  

Biomedical  

Scientists  

2  

16.67  

0  

0.00  

0  

0.00  

7  

10.00  

6  

7.79  

15  

7.73  

Total  12  

100.00  

11  

100.00  

24  

100.00  

70  

100.00  

77  

100.00  

194  

100.00  

Pearson chi2(16) – 14,3194     Pr = 0.575  

The table shows that 50.00% of nurses strongly disagree to the statement. 63.64% disagree, 50.00% 

fairly agree and 55.71% agree. Nurses who strongly agree had a percentage of 48.05%. Midwives 

responded generally within the ranges of fairly agree, 41.67%, agree, 31.43%. and strongly 

agree,37.66%. Majority of the biomedical scientists either agree, 10.00% or strongly agree, 7.79%. 

Four (4) doctors in majority represented 5.19% to strongly agree.  



 

62  

  

Table 4.14: Recognition and promotion have been a major factor for motivating staff to 

improve performance   

  Strongly 

disagreed  

Disagreed  Fairly 

agreed  

Agreed  Strongly 

agreed  

Total  

Doctors   1  

20.00  

0  

0.00  

0  

0.00  

3  

3.85  

1  

1.35  

5  

2.56  

Nurses   2  

40.00  

4  

66.67  

17  

54.84  

38  

48.72  

40  

54.05  

101  

52.06  

Midwives   2  

40.00  

1  

16.67  

9  

29.03  

29  

37.18  

26  

35.14  

67  

34.54  

Pharmacists   0  

0.00  

1  

16.67  

2  

6.45  

2  

2.56  

1  

1.35  

6  

3.09  

Biomedical  

Scientists   

0  

0.00  

0  

0.00  

3  

9.68  

6  

7.69  

6  

8.11  

15  

7.73  

Total   5 100.00  6 100.00  31  

100.00  

78  

100.00  

74  

100.00  

194  

100.00  

Pearson chi2(16) = 16.1240   Pr = 0.444  

Nurses had 54.05% against the midwives 35.14% stating that they strongly agreed that promotion 

were the major motivation to increased work performance. The same group of staff stated that 

nurses and midwives disagreed with 66.67% and 16.67% respectively. Four  

(4) doctors out of a total of 5 responded agree, 3.85% and strongly agree, 1.35% respectively. The 

same goes for biomedical scientists where twelve (12) out of 15 responded; agree, 7.69% and 

strongly agree, 8.11%.  

  



 

63  

  

Table 4.15: Improved salary is enough to meet my normal expenses and influence my 

performance   

  Strongly 

disagreed  

Disagreed  Fairly 

agreed  

Agreed  Strongly 

agreed  

Total  

Doctors  0  

0.00  

1  

16.67  

0  

0.00  

1  

1.54  

3  

4.23  

5  

2.58  

Nurses   14  

70.00  

4  

66.67  

19  

59.38  

37  

56.92  

27  

38.03  

101  

52.06  

Midwives   6  

30.00  

1  

16.67  

10  

31.25  

17  

26.15  

33  

46.48  

67  

34.54  

Pharmacists   0  

0.00  

0  

0.00  

0  

0.00  

5  

7.69  

1  

1.41  

6  

3.09  

Biomedical  

Scientists   

0  

0.00  

0  

0.00  

3  

9.38  

5  

7.69  

7  

9.86  

15  

7.73  

Total   20  

100.00  

6 100.00  32  

100.00  

65  

100.00  

71  

100.00  

194  

100.00  

Pearson chi2(16) = 26.2310      Pr = 0.051  

On how an improved salary could influence performance, majority of doctors either agreed or 

strongly agreed. Nurses who strongly disagreed recorded 70%, 66.67% disagreed. The rest of 

the responses for nurses included; fairly agree, 59.38%, agree, 56.92% and strongly agree, 

38.03%. For midwives, most of them, 46.48%, strongly agreed to the statement. All the 

pharmacists responses were either agree or strongly agree  

 

 



 

64  

  

Table 4.16: Availability of drugs and equipment increase productivity which influence(s) 

quality of health care delivery   

  Strongly 

disagreed  

Disagreed  Fairly 

agreed  

Agreed  Strongly 

agreed  

Total  

Doctor  1  

5.00  

0  

0.00  

0  

0.00  

0  

0.00  

4  

5.41  

5  

2.58  

Nurse  10  

50.00  

2  

28.57  

23  

60.53  

28  

50.91  

38  

51.35  

101  

52.06  

Midwife  7  

35.00  

4  

57.14  

14  

36.84  

20  

36.36  

22  

29.73  

67  

34.54  

Pharmacist  1  

5.00  

1  

14.29  

1  

2.63  

1  

1.82  

2  

2.70  

6  

3.09  

Biomedical  

Scientist  

1  

5.00  

0  

0.00  

0  

0.00  

6  

10.91  

8  

10.81  

15  

7.73  

Total  20  

100.00  

7 100.00  38  

100.00  

55  

100.00  

55  

100.00  

194  

100.00  

Pearson chi2(16) = 16.9953       Pr = 0.386  

Four (4) doctors in majority strongly agree with a percentage of 5.41%, 51.35% of nurses 

strongly agree being the highest. Midwives disagree with the highest percentage of 57.14%. For 

fairly agree, nurses were highest with 60.53%. The nurses were followed by midwives,  

36.84% and pharmacists, 2.63%.  

  

  

  

  



 

65  

  

Table 4.17: I see a link between motivation and performance   

  Strongly 

disagreed  

Disagreed  Fairly 

agreed  

Agreed  Strongly 

agreed  

Total  

Doctors  0  

0.00  

0  

0.00  

0  

0.00  

1  

1.66  

4  

4.65  

5  

2.57  

Nurses   7  

38.89  

11  

38.46  

5  

71.42  

40  

66.66  

38  

44.18  

101  

52.06  

Midwives   11  

61.11  

12  

47.82  

2  

28.57  

14  

23.33  

27  

31.39  

67  

34.53  

Pharmacists   0  

0.00  

0  

0.00  

0  

0.00  

1  

1.66  

5  

5.81  

6  

3.09  

Biomedical  

Scientists   

0  

0.00  

0  

0.00  

0  

0.00  

4  

6.66  

12  

13.95  

16  

8.24  

Total   18  

100.00  

23  

100.00  

7 

100.00  

60  

100.00  

86  

100.00  

194  

100.00  

Pearson chi2(16)  16.8381         Pr = 0.496  

Doctors agree, 1.66% and strongly agree with 4.65%. Same goes with pharmarcists and 

biomedical scientists who all either agree or strongly agree. Thirty-eight (38) nurses strongly 

agree with 44.18% whilst 40, 66.66% agree. On the part of midwives, 27, 31.39% strongly agree 

and 14, 23.33% agree.  

  

  

 

 



 

66  

  

  

CHAPTER FIVE  

DISCUSSION  

The discussion chapter provides a critical review of findings from data as presented in the 

preceding chapter and to appraise how well the research questions have been addressed. In 

addition, the outcome of the primary research will be linked to the literature review.   

The first objective of the study was to examine how intrinsic motivation could influence health 

workers’ performance. The findings in the following sections highlight this objective: On working 

with little or no supervision all the respondents largely sampled agreed to working with little or no 

supervision. Nurses strongly agreed by 60.71% and those who agreed were 45 in number, 48.39%. 

53.57% of nurses also fairly agree. Doctors recorded 3.57% and pharmacists, 10.71% in strongly 

agree. Nine (9), Nine (9), 39.13% of midwives disagree with the statement, but 36 of them in 

majority, 38.71% agree. Majority of biomedical scientists either agree or strongly agree. For 

instance 9 out of the 15 of them agree with 9.68%. The findings go to show that respondents in the 

study are motivated when they work with little or no supervision. In other words, they are 

comfortable to be allowed to work with some leverage, autonomy or freedom and ability to use 

discretion. This conclusion is corroborated by Mohd et al, (2012), Cerasoli et al, (2014) and Law, 

(2017) who listed supervision or control over others, responsibility, and autonomy as important 

issues capable of motivating workers to perform.  

Achievement and personal satisfaction as a motivator was tested in the study. Doctors agree with 

2.38% and 3.17% as strongly agree respectively. For biomedical scientists, majority,  

10.71% agree to the statement. Pharmacists responded with agree, 10.71% being the highest. On 

the part of nurses, 36, 57.14% strongly agree, 41 of them, 48.81% agree. Six  



 

67  

  

(6), 66.67% of nurses however disagree. In the case of midwives, 30, 35.71% agree, 20,  

31.75% strongly agree and 9, 37.56% fairly agree. Six (6) midwives strongly disagree with 42. 

87%. It thus appears from the results that respondents are motivated by their achievement and 

personal satisfaction. These views are supported by Heckhansen, (2018), who contends that 

commitment to objectives is a function of the rewards associated with their achievement. Thus 

the most important of such rewards is the satisfaction of ego and self-actualization towards 

organizational objectives. Other authors also lend credence to the finding here. Sprangler et al, 

(2014), Rheinberg at al, (2018) and Cerasoli et al, 2014 are unanimous in their agreement that 

personal satisfaction and achievement are required by some workers as their motivation for 

accomplishing tasks leading to excellent service delivery.  

Another intrinsically motivating issue raised in the study was continuous education through 

training. Doctors strongly agree, 3.41%. Nurses strongly disagree with 8, 57.14% and strongly 

agree by 53.41% with 47 of them and 31, 48.44% however indicated agree. Twenty- nine (29) and 

25 midwives respectively either strongly disagree or agree. Three (3) out of 6 pharmacists agree 

with 4.69% and 7 biomedical scientists strongly agree by 7.95%. The overwhelming support for 

continuous education and its impact on performance go to show how this intrinsic motivation is 

priceless to the respondents of this study. Dessler, (2011), substantiates these results with the 

assertion that individual employees performance is based on such factors as; personality, skills, 

knowledge, experience and abilities. Same views are expressed by Mohd et al, (2012), when they 

posit that high performance can result from appropriate behaviour and the effective use of 

knowledge, skills and competencies. Indeed these can only be acquired through continuous 

education and training.  



 

68  

  

Furthermore, findings revealed that respondents are enthused with their job security as all of them 

support the statement. Three (3) doctors, constituting the majority strongly agree same with 

biomedical scientists. The rest of the professionals were in majority by responding to either agree 

or strongly agree. The findings here confirm the views of Dessler (2011) and Mohd et al, 2012) 

that jobs should be