Unpacking the Role of Financial Incentives in the Motivation and Individual Performance of Nurses in LMICs: A Scoping Review Protocol.

BACKGROUND

Health systems in low- and middle-income countries (LMICs) continue to face persistent challenges related to health worker performance and quality of care, exacerbated by a global shortage of nurses. Financial incentive strategies (FIS), which include performance-based financing, bonuses and allowances, are extensively implemented as mechanisms to enhance the motivation and individual performance of health workers, including nurses. Nevertheless, the effects of these strategies exhibit considerable variability and are highly contingent upon specific contextual factors.

OBJECTIVE

We aim to synthesise evidence on how FIS are designed and implemented in LMICs to examine how nurse motivation and individual performance are defined and measured and to identify the underlying theoretical assumptions through which FIS may influence nurses' motivation and individual performance.

METHODS

We adopted the scoping review methodology following guidance from Arksey and O'Malley and the Joanna Briggs Institute and PRISMA-ScR reporting standards. The search will cover studies published from 2000 onwards in PubMed, Scopus, Web of Science and PsycINFO, with additional grey literature. Two reviewers will independently screen studies and extract data, with discrepancies resolved by a third reviewer. Data will be charted using a standardised form. Findings will be synthesised through narrative analysis.

RESULTS

This review will provide a comprehensive overview of FIS in LMICs, including their design and implementation features, whilst focussing on the underlying mechanisms by which FIS interventions improve the motivation and performance of nurses in LMICs.

DISCUSSION: This scoping review aims to map the existing evidence in LMICs on FIS-targeting nurses, its aspects and their relationship with motivation and individual performance and explores the theoretical assumptions of this relationship.

CONCLUSION

The findings are expected to address a significant evidence gap concerning nurse-specific workforce interventions in LMICs and to inform ongoing health policy reforms aimed at improving and sustaining motivation, retention and care delivery.