Moreover, the distribution of motivation and hygiene factors for each stage of the EKB model is uneven, and some stages include only hygiene factors.
We first explored the distribution of motivation scores among ANMs and SNs.
While there were no outliers, the distribution of motivation scores was slightly skewed to the right (skewness = −1.26).
Insufficient numbers, lack of adequately qualified or trained staff at different service levels, inadequate distribution, low motivation and poor staff retention were commonly described.
It has generally been oriented toward looking only at numbers, leaving "key questions about the distribution, qualifications, motivation, development, and performance of staff unexplored"[ 22].
Despite the policy efforts to improve availability and affordability of health care, there have been severe problems with implementation of some of these policies, as well as with the training, distribution and motivation of health care workers [ 20].
Information systems relating to the workforce are typically sketchy [ 19], and planning is technical rather than strategic in nature, [ 20] for instance leaving "key questions about the distribution, qualifications, motivation, development, and performance of staff unexplored".
The distribution of the motivation score among the nursing personnel is presented in Figure 2.
Examples include management information systems that include eye care, as has been successfully achieved in Kenya 55 and increasing the number, distribution, competencies and motivation of eye care personnel.
To meet these challenges, the rural health system needs to be more effective and efficient, and the human resources for health should be improved not only in quantity, but also with regards to equitable distribution, competency, quality, motivation, productivity, and performance [ 14].
