How can we achieve and maintain high-quality performance of health workers in low-resource settings?

A review is presented of the performance of health-workers In low and middle income countries and of strategies for improving their performances. An overview of issues and evidence about the determinants of performance is given. Health-worker practices are complex behaviours that have many potential influences. Reviews of intervention studies in low and middle income countries suggest that the simple dissemination of written guidelines is often ineffective, that supervision and audit with feedback is generally effective, and that multifaceted interventions might be more effective than single interventions. It is reported that few interventions have been evaluated with rigorous cost-effectiveness trials. 

The Lancet, Volume 366, No. 9490, p1026–1035, 17 September 2005