Motivation and sustainability of care facilitators engaged in a community home-based HIV/AIDS program in Masvingo Province, Zimbabwe

Abstract

Community home-based HIV/AIDS programs with care facilitators (CFs) are key interventions for dealing with both the shortage of health professionals (e.g., physicians, nurses, midwives, etc.) and the current HIV/AIDS epidemic in many parts of Africa. Zimbabwe, one of the sub-Saharan countries is not an exception. The Zimbabwe Red Cross Society started a community home-based HIV/AIDS program with CFs in 1992. This paper describes the results of a cross-sectional study conducted to examine the factors influencing the motivational outcome and self-assessed performance of CFs from one province involved in this program. Self-administered questionnaires provided to CFs were analyzed by chi-square test and multiple liner regression. The response rate was 71.7% (15 male, 104 female). Results showed that 46.8% of CFs in rural area had worked more than five years whilst only 18.5% of CFs in urban area did (p<0.05). The motivational outcome and self-assessed performance of CFs were significantly associated with perception toward family and community environment (beta=0.462, SE=0.092, p<0.001 and beta=0.496, SE=0.173, p<0.001, respectively) and perception toward organizational characteristics, specially managerial support, like attention from a manager, clear instruction, and goals, had an impact to CFs motivational outcome. These findings suggest that organization need to create the policy consistent with community need and provide clear goal and instruction to improve to motivation and performance of CFs.

Which intervention design factors influence performance of community health workers in low- and middle-income countries? A systematic review

“…In some cases, lack of supplies resulted in not being able to conduct the job ( Furth and Crigler 2012 ; Kalyango et al 2012 ). However, Osawa et al (2010) found no correlation between supplies and motivational outcome of CFs in Zimbabwe and in Kenya, no correlation was found between adequacy of medicine supplies in the village and guideline adherence of CHWs ( Rowe et al 2007a ).…”

“…CHWs who reported to enjoy more social prestige were more than three times as likely to remain. A cross-sectional study on Care Facilitators (CFs) working in HIV home-based care in Zimbabwe found that the more the communities accepted, appreciated and supported the CFs in their activities, the more CFs were motivated to perform ( Osawa et al 2010 ). Rowe et al (2007) found that CHWs working in child health in Kenya showed better guideline adherence when they reported to receive respect from the community.…”

“…CBSVs in Kenya were proud of their job and said they gained respect and recognition from the community, elders and district health staff, leading to motivation ( Dil et al 2012 ). CFs in Zimbabwe felt motivated by organizational characteristics like managerial support, but their performance was not influenced by organizational characteristics ( Osawa et al 2010 ).…”

How does context influence performance of community health workers in low- and middle-income countries? Evidence from the literature

“…A lack of financial or material compensation for services rendered could lead to an inability of CHWs to provide for their family and is particularly exacerbated in areas of pervasive poverty [ 62 ]. The willingness to become a CHW could be influenced by the wish to earn an income or the hope of being compensated eventually, especially in situations where there is high unemployment or fewer opportunities [ 64 , 76 - 78 ]. For example, a study on CBDs in Uganda reported that, due to high levels of unemployment, people volunteered hoping that they would be remunerated eventually [ 77 ].…”

Towards Promotion of Community rewards to Volunteer Community Health Workers? Lessons from Experiences of Village Health Teams in Luwero, Uganda

“…CHWs have been assigned diverse roles and activities throughout their history, both within and across countries, targeting a wide range of preventive, curative and/or developmental interventions (Gilmore & McAuliffe, 2013). CHWs are seen as pivotal in increasing accessibility to Primary Healthcare (PHC) services (Osawa, Kodama, & Kundishora, 2010).…”