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Sociocultural and individual determinants for motivation of sexual and reproductive health workers in Papua New Guinea and their implications for male circumcision as an HIV prevention strategy

Anna Tynan1*, Andrew Vallely23, Angela Kelly34, Martha Kupul3, James Neo3, Richard Naketrumb3, Herick Aeno3, Greg Law5, John Milan5, Peter Siba3, John Kaldor2, Peter S Hill1 and and on behalf of the Male Circumcision Acceptability and Impact Study, PNG

Author Affiliations

1 Australian Centre for International & Tropical Health, School of Population Health, University of Queensland, Herston Road, Herston, Queensland, 4006, Australia

2 Public Health Interventions Research Group, Kirby Institute, University of New South Wales, Cliffbrook Campus, 45 Beach Street, Coogee, New South Wales, 2034, Australia

3 Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, P.O. Box 60, Goroka, Eastern Highlands Province, 441, Papua New Guinea

4 International HIV Research Group, School of Public Health and Community Medicine, University of New South Wales, High Street, Kensington, 2052, Australia

5 Sexual Health and Disease Control Branch, National Department of Health, P.O. Box 807, Waigani, National Capital District, 131, Papua New Guinea

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Human Resources for Health 2013, 11:7  doi:10.1186/1478-4491-11-7

Published: 19 February 2013



The motivation of health workers (HWs) to deliver services in developing countries has been described as a critical factor in the success of health systems in implementing programmes. How the sociocultural context of Papua New Guinea (PNG) affects the values, motivation and actions of HWs involved in sexual and reproductive health services is important for policy development and programme planning. With interest in male circumcision (MC) as an HIV prevention option in PNG, this study explored the perceptions and motivations of HWs involved in sexual and reproductive health services in PNG, examining their implications for the possible future roll out of a national MC programme.


A multi-method qualitative study was conducted with HWs across a range of health care professions working in sexual health facilities. A total of 29 in-depth interviews and one focus group discussion were completed. Qualitative thematic analysis of the transcripts and field notes was undertaken using a social constructivist approach and complemented by documentary organizational, programme and policy analysis.

Results and discussions

Introduction of new health programmes, such as a MC programme for HIV prevention, are likely to impact upon one or more of the many motivational determinants. Social–cultural and individual factors influencing HW motivation to be involved in sexual and reproductive health services in PNG included community expectation and concern, sense of accomplishment and religious conviction. Strong links to community responsibility outweighed organizational ties. Faced with an often dysfunctional work environment, HWs perceived themselves as responsible to compensate for the failed health system. The impact of community influence and expectation needs to be considered when introducing a MC programme, particularly to communities in PNG where penile foreskin cutting is a common and accepted practice.


The potential contribution to the success of a MC programme that HWs may have means that taking into account the differing needs of communities as well as the motivational influences on HWs that exist within the sociocultural environment is important. These findings will assist not only in programme planning for MC, but also in the expansion of other existing sexual and reproductive health services.