A planned evidence review will map how financial incentives are designed and implemented for nurses in low- and middle-income countries, and how studies measure motivation and individual performance. Its protocol lays out a way to organize that evidence; it does not report a completed finding about whether a particular scheme works.
The questions behind the review
The protocol divides its central question into several parts. It asks how financial-incentive strategies are designed and implemented; how nurse motivation and individual performance are defined and measured; and what theoretical assumptions are used to link incentives with those concepts.
To make those links explicit, the review will consider agency, expectancy, self-determination and psychological contract theories. The protocol presents them as possible explanations for relationships among incentives, motivation and performance, not as conclusions already established by the review.
A broad search with a defined boundary
The eligibility rules focus on evidence from low- and middle-income country health systems about nurses, including nurse subgroups. The protocol accepts material in Arabic, French or English and sets the inclusion period from 2000 to the current date.
The search will use four bibliographic databases: Scopus, Web of Science, PubMed and PsycINFO. It will also look for grey literature, meaning relevant reports and other sources outside the standard journal-database search.
Study selection will cover both primary studies and grey-literature sources. Two independent reviewers will screen titles, abstracts and full texts in Rayyan. If they disagree, a third reviewer will resolve the discrepancy, while reasons for exclusion will be recorded. The protocol was registered with the Open Science Framework on 24 March 2026.
How the evidence will be handled
Before full data collection, the charting form will be piloted across five studies. Two reviewers will independently extract the information, and inter-rater agreement, meaning the level of consistency between reviewers, will be measured on a random sample of 20% of included studies. The authors state that no methodological quality appraisal will be conducted.
The planned synthesis will combine numerical description with qualitative methods. It will use narrative analysis to examine financial-incentive design in relation to motivation and individual performance, with reviewer discussion and third-reviewer arbitration where needed. Reporting will follow PRISMA-ScR, the reporting framework named in the protocol for scoping reviews.
A map, not a verdict
That planned output is an overview of financial-incentive design and implementation in low- and middle-income countries, together with an examination of the mechanisms proposed to relate those strategies to nurses' motivation and individual performance. It is meant to organize the field, not to provide a completed answer about effectiveness.
The authors characterize financial incentives as context-dependent. They say resource shortages, infrastructure problems, delayed payments, inequity, workload and hierarchical management may accompany ineffective or distorted implementation. They also say incentives cannot substitute for adequate salaries and working conditions.
The authors' warning is that incentives should be read in the conditions in which they are delivered. The protocol is designed to examine those design and implementation questions, as well as the assumptions used to connect an incentive with motivation and individual performance. Until that work is completed, the document offers a route for reviewing the evidence, not evidence that a particular financial strategy improves nurses' motivation or performance.
Paper data and sources
Original title: Unpacking the Role of Financial Incentives in the Motivation and Individual Performance of Nurses in LMICs: A Scoping Review Protocol
Authors: Selmi A, Djibrine D, Belrhiti Z
Journal/Repository: Public health challenges
Status: Peer-reviewed
First online: 2026-10-11
DOI: Not available
Original paper · Full text