Understanding motivating and demotivating factors among maternal healthcare professionals in Somalia: a qualitative interview study

INTRODUCTION: Motivated health workers are pivotal in providing adequate health services. This study aims to understand what motivates and demotivates maternal health workers. We do so in Somalia, an understudied country in Africa with pervasive security challenges and one of the highest avoidable maternal mortality rates. METHODS: This qualitative study explores health workers' motivation in three tertiary hospitals in the capital, Mogadishu. Twenty skilled healthcare professionals were interviewed, including nurses, midwives, physicians, specialists and supervisors. The interviews were transcribed verbatim and analysed using thematic analysis. RESULTS: Key factors influencing healthcare workers' motivation include job satisfaction, monetary and work-related support, effective managerial practices, career development and intrinsic motivation. Most health workers expressed a powerful combination of altruism, volunteerism and religious conviction, driving their professional commitment to the community. Challenges that led to demotivation included high patient volume, staff shortages, limited supplies, infrastructural constraints, unregulated managerial practices and health system limitations. While most health workers primarily wanted to meet patients' needs and did not consider salary a decisive motivating factor, others were demotivated by low pay and heavy workload. CONCLUSION: Maternal health workers in Somalia face challenges that impact their motivation. Mitigating burnout through workload management and continued education can contribute to a more motivated and resilient healthcare workforce. Policy recommendations include offering long-term contracts, providing access to training and implementing fair and transparent employment policies. Further research is needed to evaluate the effectiveness of both financial and non-financial incentives in motivating health workers in Somalia.