Demotivating the Doctors: The Double Demotivation Hypothesis in the Health Services of Less‐developed Countries

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Abstract
The health services of many less‐developed countries continue to struggle. Donors also continue to contribute money, equipment and personnel in the hope of producing sustainable improvements in these health services. Despite this cumulative effort over many years, some health services in Africa have failed to make significant gains. Suggests that the giving of aid, through the provision of medical and other personnel, produces a potentially damaging double standard. In particular, the dramatic dichotomy in the renumerations of local and foreign doctors may have the unintended, but damaging, effect of demotivating local staff. In addition, reviews research which supports the notion that the higher‐paid foreign doctors may also experience a demotivation, through being focused on extrinsic rather than intrinsic aspects of their work. Discusses implications of this double demotivation – in local as well as foreign doctors – for the provision of medical personnel in less‐developed countries.

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