Retention of female volunteer community health workers in Dhaka urban slums: a prospective cohort study

Abstract

BackgroundVolunteer community health workers (CHWs) are a key approach to improving community-based maternal and child health services in developing countries. BRAC, a large Bangladeshi non-governmental organization (NGO), has employed female volunteer CHWs in its community-based health programs since 1977, recently including its Manoshi project, a community-based maternal and child health intervention in the urban slums of Bangladesh. A case–control study conducted in response to high dropout rates in the first year of the project showed that financial incentives, social prestige, community approval and household responsibilities were related to early retention in the project. In our present prospective cohort study, we aimed to better understand the factors associated with retention of volunteer CHWs once the project was more mature.MethodsWe used a prospective cohort study design to examine the factors affecting retention of volunteer CHWs who remained in the project after the initial start-up period. We surveyed a random sample of 542 CHWs who were working for BRAC Manoshi in December 2008. In December 2009, we revisited this cohort of CHWs and interviewed those who had dropped out about the main reasons for their dropping out. We used a multivariable generalized linear model regression analysis with a log link to estimate the relative risk (RR) of independent factors on retention.ResultsOf the 542 CHWs originally enrolled, 120 had dropped out by the end of one year, mainly because they left the slums. CHWs who received positive community appraisal (adjusted RR = 1.45, 95% confidence interval (CI) = 1.10 to 1.91) or were associated with other NGOs (adjusted RR = 1.13, 95% CI = 1.04 to 1.23) were more likely to have been retained in the project. Although refresher training was also associated with increased retention (adjusted RR = 2.25, 95% CI = 1.08 to 4.71) in this study, too few CHWs had not attended refresher training regularly to make it a meaningful predictor of retention that could be applied in the project setting.ConclusionFactors that affect retention of CHWs may change over time, with some factors that are important in the early years of a project losing importance as the project matures. Community health programs operating in fragile urban slums should consider changing factors over program duration for better retention of volunteer CHWs.

Fatores que influenciam na qualidade de vida dos agentes comunitários de saúde

“…The socioeconomic profile of Community Health Workers of this study was similar to that found in other regions of Brazil (7)(8)(9) and countries, such as India (10) and Kenya, (11) being characterized by women, married, with over 12 years of education in young adult age group. These data reflect the participation of women in the labor market, allowing greater family income and women's social advancement and performance, instinctively, the caregiver role in society and community resistance to the Community Health Worker male, due to embarrassment of families in revealing specificities.…”

“…These data reflect the participation of women in the labor market, allowing greater family income and women's social advancement and performance, instinctively, the caregiver role in society and community resistance to the Community Health Worker male, due to embarrassment of families in revealing specificities. (10) Furthermore, this research reveals that the female associated with lower quality of life scores on the physical functioning, physical role functioning, bodily pain, vitality and Social role functioning, demonstrates women's vulnerability to occupational diseases, mainly to physical disorders that generate pain and compromise labor quality. (12) The double shift female working hours requires the reconciliation of family care with the tasks of the Community Health Workers, which often require long walks, lifting weights, sitting in the wrong position at home visits and constant responsibility to mediate conflicts between the community and health services, causing overload and the appearance of diseases.…”

Availability and Quality of Emergency Obstetric and Newborn Care in Bangladesh

“…healthcare staff can be retained through recognition, 65 positive appraisal, 66 financial incentive, 65,67 and ensuring adequate resources and appropriate infrastructure. 65 This is one of the first studies to assess the availability of EmNC signal functions in Bangladesh.…”

Promoting community malaria control in rural Myanmar through an active community participation program using the participatory learning approach

“…Additional motivational factors included incentives in terms of money, materials and technical support. Similar factors enabling the retention of community health workers in community-based health programs have been reported in other studies [10][11][12] .…”