Understanding community health worker incentive preferences in Uganda using a discrete choice experiment

Agarwal, Smisha; Abuya, Timothy; Kintu, Richard; Mwanga, Daniel; Pandya, Shivani; Warren, Charlotte E.

doi:10.7189/jogh.11.07005

Cited by 23 publications

(19 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…73 However, high attrition rate is a major challenge to CHW programmes such as VHTs in Uganda due to poor governmental support. 74 Given the readily available telephone communication in East Africa, the integration of a mobile health (mHealth) programme specifically for maternal care-seeking in the existing mHealth structure in Kenya 75 and Uganda 76 is another viable approach. A cost-free two-way mHealth messaging approach could facilitate follow-up, counter sociodemographic barriers and profoundly improve continued care seeking.…”

Section: Discussionmentioning

confidence: 99%

Determinants of continued maternal care seeking during pregnancy, birth and postnatal and associated neonatal survival outcomes in Kenya and Uganda: analysis of cross-sectional, demographic and health surveys data

2021

View full text Add to dashboard Cite

ObjectivesTo examine how maternal and sociodemographic factors determine continued care-seeking behaviour from pregnancy to postnatal period in Kenya and Uganda and to determine associated neonatal survival outcomes.DesignA population-based analysis of cross-sectional data using multinomial and binary logistic regressions.SettingCountrywide, Kenya and Uganda.ParticipantsMost recent live births of 24 502 mothers within 1–59 months prior to the 2014–2016 Demographic and Health Surveys.OutcomesCare-seeking continuum and neonatal mortality.ResultsOverall, 57% of the mothers had four or more antenatal care (ANC) contacts, of which 73% and 41% had facility births and postnatal care (PNC), respectively. Maternal/paternal education versus no education was associated with continued care seeking in majority of care-seeking classes; relative risk ratios (RRRs) ranged from 2.1 to 8.0 (95% CI 1.1 to 16.3). Similarly, exposure to mass media was generally associated with continued care seekin; RRRs ranged from 1.8 to 3.2 (95% CI 1.2 to 5.4). Care-seeking tendency reduced if a husband made major maternal care-seeking decisions. Transportation problems and living in rural versus urban were largely associated with lower continued care use; RRR ranged from 0.4 to 0.7 (95% CI 0.3 to 0.9). The two lowest care-seeking categories with no ANC and no PNC indicated the highest odds for neonatal mortality (adjusted OR 4.2, 95% CI 1.6 to 10.9). 23% neonatal deaths were attributable to inadequate maternal care attendance.ConclusionStrategies such as mobile health specifically for promoting continued maternal care use up to postnatal could be integrated in the existing structures. Another strategy would be to develop and employ a brief standard questionnaire to determine a mother’s continued care-seeking level during the first ANC visit and to use the information to close the care-seeking gaps. Strengthening the community health workers system to be an integral part of promoting continued care seeking could enhance care seeking as a stand-alone strategy or as a component of aforementioned suggested strategies.

show abstract

Section: Discussionmentioning

confidence: 99%

Determinants of continued maternal care seeking during pregnancy, birth and postnatal and associated neonatal survival outcomes in Kenya and Uganda: analysis of cross-sectional, demographic and health surveys data

2021

View full text Add to dashboard Cite

show abstract

“…This finding resonates with studies that show that CHWs require various forms of support, including training, supplies, and supportive supervision to effectively prepare them for their roles in service delivery, particularly when new knowledge or skills are required. 32 , 33 Efforts to alleviate these shortages and provide CHWs performing new duties with proportional incentives may help boost morale and lessen the related negative consequences (i.e., increased workloads). 21 Our findings align with outbreak studies that show CHW challenges in prioritizing routine responsibilities while adopting new ones without clear government guidance and support.…”

Section: Discussionmentioning

confidence: 99%

Examining Roles, Support, and Experiences of Community Health Workers During the COVID-19 Pandemic in Bangladesh: A Mixed Methods Study

Roy¹,

Kennedy²,

Hossain³

et al. 2022

Glob Health Sci Pract

View full text Add to dashboard Cite

During the first wave of the coronavirus disease (COVID-19) pandemic in Bangladesh, across all health areas, community health workers (CHWs) described a slight decrease in the routine services they were able to provide due to restrictions in movement posed by lockdowns and other challenges.nThe government and various nongovernmental organizations provided supportive mechanisms to CHWs through training, supplies, and supportive supervision; however, these supports were not always uniformly distributed across cadres, leading to some discontent among CHWs. n CHWs were crucial actors in the government's COVID-19 response, as they took on new pandemic-related responsibilities in their communities to prevent the spread of the disease while continuing their routine work.

show abstract

“…17 The use of DCEs to assess the preferences of CHWs, particularly volunteer CHWs, has steadily grown since 2014. [17][18][19][20][21][22][23] Findings often highlight that a mix of financial and nonfinancial incentives are critical to support the motivation, performance and retention of CHWs. For instance, in Kenya, Abuya and colleagues found that transport was considered the most important incentive attribute for volunteer CHWs, followed by tools of trade and job incentives that offered higher monthly stipends.…”

Section: Bmj Global Healthmentioning

confidence: 99%

Understanding community health worker employment preferences in Malang district, Indonesia, using a discrete choice experiment

et al. 2022

View full text Add to dashboard Cite

BackgroundCommunity health workers (CHWs) play a critical role in supporting health systems, and in improving accessibility to primary healthcare. In many settings CHW programmes do not have formalised employment models and face issues of high attrition and poor performance. This study aims to determine the employment preferences of CHWs in Malang district, Indonesia, to inform policy interventions.MethodsA discrete choice experiment was conducted with 471 CHWs across 28 villages. Attributes relevant to CHW employment were identified through a multistage process including literature review, focus group discussions and expert consultation. Respondents’ choices were analysed with a mixed multinomial logit model and latent class analyses.ResultsFive attributes were identified: (1) supervision; (2) training; (3) monthly financial benefit; (4) recognition; and (5) employment structure. The most important influence on choice of job was a low monthly financial benefit (US$~2) (β=0.53, 95% CI=0.43 to 0.63), followed by recognition in the form of a performance feedback report (β=0.13, 95% CI=0.07 to 0.20). A large monthly financial benefit (US$~20) was most unappealing to respondents (β=−0.13, 95% CI=−0.23 to −0.03). Latent class analysis identified two groups of CHWs who differed in their willingness to accept either job presented and preferences over specific attributes. Preferences diverged based on respondent characteristics including experience, hours’ worked per week and income.ConclusionCHWs in Malang district, Indonesia, favour a small monthly financial benefit which likely reflects the unique cultural values underpinning the programme and a desire for remuneration that is commensurate with the limited number of hours worked. CHWs also desire enhanced methods of performance feedback and greater structure around training and their rights and responsibilities. Fulfilling these conditions may become increasingly important should CHWs work longer hours.

show abstract

Understanding community health worker incentive preferences in Uganda using a discrete choice experiment

Cited by 23 publications

References 33 publications

Determinants of continued maternal care seeking during pregnancy, birth and postnatal and associated neonatal survival outcomes in Kenya and Uganda: analysis of cross-sectional, demographic and health surveys data

Determinants of continued maternal care seeking during pregnancy, birth and postnatal and associated neonatal survival outcomes in Kenya and Uganda: analysis of cross-sectional, demographic and health surveys data

Examining Roles, Support, and Experiences of Community Health Workers During the COVID-19 Pandemic in Bangladesh: A Mixed Methods Study

Understanding community health worker employment preferences in Malang district, Indonesia, using a discrete choice experiment

Contact Info

Product

Resources

About