Understanding the motivation and performance of community health volunteers involved in the delivery of health programmes in Kampala, Uganda: a realist evaluation

Abstract

ObjectivesThis paper presents the results of a realist evaluation that aimed to understand how, why and under what circumstances a Red Cross (RC) capacity-building intervention influences the motivation and the performance of RC community health volunteers involved in the delivery of an immunisation programme in Kampala, Uganda.MethodGiven the complexity of the intervention, we adopted realist evaluation as our methodological approach and the case study as our study design. Data collection included document review, participant observation and interviews. The constant comparative method was used for the analysis. Two contrasted cases were selected within the five Kampala districts. Each case covers the management of the immunisation programme implemented at a RC branch. In each case, a programme manager and 15 RC volunteers were interviewed. The selection of the volunteers was purposive.ResultsWe found that a capacity-building programme including supervision supportive of autonomy, skills and knowledge enhancement, and adapted to the different subgroups of volunteers, leads to satisfaction of the three key drivers of volunteer motivation: feelings of autonomy, competence and connectedness. This contributes to higher retention, and better task performance and well-being among the volunteers. Enabling contextual conditions include the responsiveness of the Uganda Red Cross Society (URCS) to community needs, and recognition of the work of the volunteers, from the URCS and the community.ConclusionsA management approach that caters for the different motivational states and changing needs of the volunteers will lead to better performance. The findings will inform not only the management of community health volunteers, but also the management of all kinds of health workers.

Understanding the performance of community health volunteers involved in the delivery of health programmes in underserved areas: a realist synthesis

“…Indeed, the programme theory that explains how and why the volunteerism intervention is expected to produce outcomes should be developed ideally both from the literature and the voice of the main stakeholders (programme designers, managers and volunteers). Drawing on a programme theory that is sensitive to context and tested by empirical studies is more likely to lead to the development of effective interventions when aiming to improve motivation and performance of CHVs [ 80 ].…”

Global Health Research, Anthropology and Realist Enquiry

“…The scope of the most recent RE conference in Brisbane in 2017 included realist research as did the recently published reference work Doing Realist Research (Emmel et al 2018). This refl ects the broader application of RE in global health research, for instance in research on policy implementation, accountability (Van Belle 2014), programme implementation (Mukumbang et al 2018(Mukumbang et al , 2016, hospital management (Marchal 2011), district management (Kwamie 2016), capacity development (Prashanth et al 2014), and health volunteerism (Vareilles et al 2015).…”

Which mechanisms explain motivation of primary health workers? Insights from realist evaluation of a maternal and child health programme in Nigeria

“…These findings have implications for developing strategies that ensure supportive supervision and strengthening community ties, establishing a fair recognition and reward system, and providing opportunities for training and career enhancement for health staff. While many studies focused on highly-performing workers and institutions, or on specific cadres of workers e.g., community health volunteers to identify what motivations and mechanisms drive good performance (18,37,(44)(45)(46)(47), our study assessed how motivation worked among different cadres of PHC workers (doctors, nurses, midwives, and CHEWs) in a dynamic institutional environment generated by changing health sector reform policy.…”

“…Despite the growing interest in the drivers and mechanisms of work motivation, only three realist evaluation studies of mechanisms of workforce motivation were identified, two of which drew on selfdetermination theory to research motivation in autonomous community health volunteers in Uganda (18) and in top-performing community health teams in El Salvador (19) respectively. The third study combined the Herzberg's two-factor theory of needs with the person-environment fit theory to identify mechanisms of employee turnover in Ethiopia (20).…”