Sources of community health worker motivation: a qualitative study in Morogoro Region, Tanzania

Abstract

BackgroundThere is a renewed interest in community health workers (CHWs) in Tanzania, but also a concern that low motivation of CHWs may decrease the benefits of investments in CHW programs. This study aimed to explore sources of CHW motivation to inform programs in Tanzania and similar contexts.MethodsWe conducted semi-structured interviews with 20 CHWs in Morogoro Region, Tanzania. Interviews were digitally recorded, transcribed, and coded prior to translation and thematic analysis. The authors then conducted a literature review on CHW motivation and a framework that aligned with our findings was modified to guide the presentation of results.ResultsSources of CHW motivation were identified at the individual, family, community, and organizational levels. At the individual level, CHWs are predisposed to volunteer work and apply knowledge gained to their own problems and those of their families and communities. Families and communities supplement other sources of motivation by providing moral, financial, and material support, including service fees, supplies, money for transportation, and help with farm work and CHW tasks. Resistance to CHW work exhibited by families and community members is limited. The organizational level (the government and its development partners) provides motivation in the form of stipends, potential employment, materials, training, and supervision, but inadequate remuneration and supplies discourage CHWs. Supervision can also be dis-incentivizing if perceived as a sign of poor performance.ConclusionsTanzanian CHWs who work despite not receiving a salary have an intrinsic desire to volunteer, and their motivation often derives from support received from their families when other sources of motivation are insufficient. Policy-makers and program managers should consider the burden that a lack of remuneration imposes on the families of CHWs. In addition, CHWs’ intrinsic desire to volunteer does not preclude a desire for external rewards. Rather, adequate and formal financial incentives and in-kind alternatives would allow already-motivated CHWs to increase their commitment to their work.

Motivation of health surveillance assistants in Malawi: A qualitative study

“…With the exception of research conducted in Tanzania, 7 this is the first time these frameworks have been applied to analyse motivation of CHWs in Africa. Our analysis identified five key themes shaping HSA motivation: salary, accommodation, human resource management, supplies and logistics, and community links.…”

“…5 There has been growing global interest in assessing how motivation shapes performance of CHWs. [6][7][8] Motivation can be defined as "an individual's degree of willingness to exert and maintain effort towards organisational goals. 9 " Motivation is linked to notions of self-fulfilment, achievement, and recognition.…”

La perspectiva de los agentes sanitarios sobre la incorporación programática de la autotoma del test de VPH

“…El reco-Cad. Saúde Pública 2017; 33(4):e00138515 nocimiento de la comunidad sobre la labor de los agentes sanitarios funciona como incentivo para la realización de las tareas de los agentes 14,27 y, en algunos casos, dicho reconocimiento suplementa la ausencia de incentivos por parte del sistema formal de salud 28 . En el contexto jujeño, la mención de los agentes sanitarios sobre el fortalecimiento de su vínculo con las mujeres a su cargo fue superior a la demanda de incentivos materiales (monetarios/no monetarios).…”

“…En el contexto jujeño, la mención de los agentes sanitarios sobre el fortalecimiento de su vínculo con las mujeres a su cargo fue superior a la demanda de incentivos materiales (monetarios/no monetarios). En ese sentido, este estudio disiente con otros en los que la ausencia de incentivos materiales fueron el principal obstáculo percibido por los agentes sanitarios para la implementación y/o sostenibilidad de una estrategia 14,28,29 .…”

“…En lo que respecta específicamente a la sobrecarga de trabajo, los agentes participantes de este estudio -sin importar el GMO-la señalaron como el principal aspecto negativo de haber ofrecido la autotoma, la principal razón para no incorporarla y el principal obstaculizador de la tarea. La sobrecarga de trabajo es un aspecto de las condiciones de trabajo que impacta directamente en el desempeño de la labor de los agentes sanitarios 19,28,36,37 . Dadas las características del ofrecimiento de la autotoma -para el cual los agentes sanitarios deben tomarse un tiempo para dialogar con la mujer, responder a dudas que puedan surgir y trasladar el tubo hasta el centro de salud-la estrategia tiene un importante potencial de sobrecarga de trabajo.…”