Factors contributing to motivation of volunteer community health workers in Ethiopia: the case of four woredas (districts) in Oromia and Tigray regions

Abstract

BackgroundThe use of community health workers (CHWs) has been considered as one of the strategies to address the growing shortage of health workers, predominantly in low-income countries. They are playing a pivotal role in lessening health disparities through improving health outcomes for underserved populations. Yet, little is known about what factors motivate and drive them to continue working as CHWs. In this study, we aimed to examine factors contributing to the motivation of volunteer CHWs (vCHWs) in Ethiopia currently known as one-to-five network leaders (1to5NLs) and explore variations between attributes of social and work-related determinants.MethodWe conducted a cross-sectional study in four selected woredas (the second lowest administrative structure in Ethiopia, and similar to a district) of Oromia and Tigray regions and interviewed 786 1to5NLs. The effects of each motivational factor were explored using percentage of respondents who agreed and strongly agreed to each of them and Mann-Whitney U test.ResultsIndividual, community, and health system factors contributed to the motivation of 1to5NLs in this study. Intrinsic desire to have a good status in the community as a result of their volunteer service (81.86%) followed by a commitment to serve the community (81.61%) and to gain satisfaction by accomplishing something worthwhile to the community (81.61%) were some of the factors motivating 1to5NLs in our study. Despite these motivational items, factors such as lack of career development (51.47%), unclear health development army guideline (59.26%), limited supervision and support (62.32%), and lack of recognition and appreciation of accomplishments (63.22%) were the factors negatively affecting motivation of 1to5NLs. Lack of career development, limited supervision and support, and lack of recognition and appreciation of accomplishments were significantly varied between attributes of educational level, marital status, service year as 1to5NLs, and previous volunteer engagement (at P < 0.05).ConclusionFindings of our study indicated that non-financial incentives such as the creation of career development models is the key to motivating and retaining CHWs where they are not receiving stipends. Sustainability of CHW program should consider exploring enhanced innovations to strengthen supportive supervision, development of better mechanisms to publicize the role of CHWs, and improvement of recognition and appreciation schemes for CHWs’ efforts and accomplishments.

What motivates individuals to volunteer in Ebola epidemic response? A structural approach in Guinea

“…The items were devised in multiple ways. First, a list of items was created by the investigators on the basis of previous studies on motivations for volunteering in community health programs [14–20, 23, 24]. This list was then shown consecutively to two focus groups of eight volunteers each who, under the direction of one of the authors, reformulated items judged as ambiguous and suggested additional items.…”

“…Our first hypothesis, based on previous studies [14–20, 23, 24], was that at least six different kinds of motives for volunteering in Ebola response programs would be found: (1) a feeling of patriotic duty, (2) a feeling of moral responsibility, (3) a desire to use one’s skills for a collective good, (4) compliance with authority, (5) a desire to gain community recognition, and (6) a seeking for personal growth. Our second hypothesis, based on the devastating consequences of Ebola in the affected poor countries in West Africa [1–3], was that the most important motives would be patriotism and feelings of moral responsibility toward fellow citizens and that the contribution of the other motives would be relatively moderate.…”

The supervisory relationships of community health workers in primary health care: social network analysis of ward-based outreach teams in Ngaka Modiri Molema District, South Africa

“…Such a holistic conception requires viewing supervision not just as a dyadic relationship between a supervisee and their immediate line supervisor,10–14 but rather as a system operating at several levels with a range of functions involving different actors and relationships and forms of interaction, for example, one-on-one, group and peer supervision, and so on, simultaneously 7 9. In this sense, supervision can be thought of as a set of relationships embedded in the wider context of social and professional relationships and hierarchies within the health system.…”

Who could be One Health Activist at the community level?: A case for India

“…Given the issues and challenges, some of India’s state governments started to formalize the payment to FHWs as a monthly salary rather than incentives, which is one of the most welcome steps towards improving their motivation. In addition, the intervention studies on enhancing the motivation of CHWs recommend interdisciplinary actions, such as cross-cutting approaches, training, supervision, incentives, career development, and ownership [ 52 , 53 ]. While the OH activities are drawing attention to the cross-cutting approaches with its interdisciplinary nature, these might attract the targeted FHWs in building and developing more satisfaction from their work performance.…”