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Caffe began by discussing the importance of incentives for health workers’ improvement. Governments should have a continuing dialogue with health workers to understand what motivates them to improve their quality. This goes beyond financial incentives to include recognition, acknowledgement, and career advancement.
Chandra-Mouli mentioned ways to increase accountability at the local level—including checklists, scorecards, public hearings, and audits. At the national level, we can think more broadly. For example, in 2014, India launched a large adolescent health program. Two years in, the government recognized it was not going as well as they’d hoped. They worked with WHO to do a review in four states and at the national level. Government leaders accepted the constructive criticism from WHO and other stakeholders, because it was a safe space and they had an overall commitment to improve. We need to create and encourage a collaborative, trusting environment to talk about mistakes. We don’t want to celebrate avoidable failures—for example, if a program does not do a situation analysis and the program failed. However, if a program makes mistakes while doing the best they can, and learns from these mistakes, this should be celebrated.
Ajani agreed that governments need to find ways to motivate health workers, and not necessarily with money. Governments need to offer ways for health workers to advance in their career paths, based on performance and competencies in adolescent reproductive health. Governments also need to coordinate training—so partners are not training the same participants—in order to maximize resources.
Chandra-Mouli added that, while we need to hold health workers accountable, we also need to celebrate their work and recognize the challenges they face. Health workers need to be paid on time, they need to be treated fairly, and they need protective equipment so they can be safe and provide good quality care. We need to create a chain of accountability: Before holding health workers accountable, we need to ensure that governments protect and support health workers.