Motivation of Community Health Workers in Diagnosing, Treating, and Referring Sick Young Children in a Multicountry Study

Abstract

Background. Community health workers (CHWs) are an important element of care provision for a wide range of conditions, but their turnover rate is high. Many studies have been conducted on health workers’ motivation, focusing on formal sector staff but not CHWs. Although CHWs are easy to recruit, motivating and retaining them for service delivery is difficult. This article investigates factors influencing CHW motivation and retention in health service delivery.Methods. Quantitative and qualitative data were collected to identify the key factors favoring motivation and retention of CHWs as well as those deterring them. We interviewed 47, 25, and 134 CHWs in Burkina Faso, Nigeria, and Uganda, respectively, using a structured questionnaire. Focus group discussions (FGDs) were also conducted with CHWs, community participants, and facility health workers.Results. Except for Burkina Faso, most CHWs were female. Average age was between 38 and 41 years, and most came from agricultural communities. The majority (52%–80%) judged they had a high to very high level of satisfaction, but most CHWs (approximately 75%) in Burkina Faso and Uganda indicated that they would be prepared to leave the job, citing income as a major reason. Community recognition and opportunities for training and supervision were major incentives in all countries, but the volume of unremunerated work, at a time when both malaria-positive cases and farming needs were at their peak, was challenging.Conclusions. Most CHWs understood the volunteer nature of their position but desired community recognition and modest financial remuneration.Clinical Trials Registration. ISRCTN13858170.

Community Health Workers in Diabetes Prevention and Management in Developing Countries

“…Additionally, examination of CHW satisfaction and perceptions of barriers is necessary. 71 Future research needs to incorporate measures for determining quality of life, health care use, and cost-effectiveness. Additional cost-effectiveness studies can help determine whether CHW interventions are a cost-effective alternative to other diabetes-related health interventions.…”

Quantifying and Valuing Community Health Worker Time in Improving Access to Malaria Diagnosis and Treatment

“…Using the average income in each country for people of equivalent education and experience, the estimated value of their time during 1 year ranged from USD $51.9 in Burkina Faso to USD $294.9 in Nigeria. Some CHWs, but not all, benefited from payments in kind; most stated gaining improved community status; and all were supervised [15]. Each of these incentives contributed to the success of the intervention and increased motivation.…”

“…Financial remuneration may well be CHWs’ preferred option, but policies intent upon reducing their attrition rates and maintaining their effectiveness will need to respond to what motivates them. Sanou et al [15] indicate that a substantial component of CHWs’ motivation derives from their status in the community and technical supervision; these 2 components apparently reinforce their technical skills (and hopes of a career path) and link them to community members and the formal health system. If CHWs are highly motivated by community status, then policies can be designed to reinforce that status; if they are motivated more by income prospects, then compensation for their time needs to be structured in a way that improves income and efficient use of time (ie, reduces incentives to “waste time”).…”

“…Nonfinancial incentives, such as training, adequate supervision, community recognition, certification, identification badges, reduced stockouts, and bicycles that are appropriate for the CHWs' work were mentioned by CHWs as helping to increase their sense of self-worth, a source of pride, and relevant to future job prospects [15]. They indicate that CHWs’ motivation, retention, and effectiveness is heavily influenced by who they are in the community context, how they are perceived by community members, and the extent to which they are supported to maintain a stable relationship with their clients.…”

“They have been neglected for a long time”: a qualitative study on the role and recognition of Rural Health Motivators in the Shiselweni region, Eswatini

“…Globally, the lack of recognition of CHWs in MoH programmes has been cited as a challenge [19,40,[43][44][45]. Increased recognition is seen as potentially improving lay health worker performance [41].…”