Understanding Factors That Support Community Health Worker Motivation, Job Satisfaction, and Performance in Three Ugandan Districts: Opportunities for Strengthening Uganda’s Community Health Worker Program

Abstract

Background: Uganda’s community health worker (CHW) program experiences several challenges related to the appropriate motivation, job satisfaction, and performance of the CHW workforce. This study aims to identify barriers in the effective implementation of financial and non-financial incentives to support CHWs and to strengthen Uganda’s CHW program. Methods: The study was implemented in Uganda’s Lira, Wakiso, and Mayuge districts in May 2019. Ten focus group discussions (FGD) were held with 91 CHWs, 17 in-depth interviews (IDI) were held with CHW supervisors, and 7 IDIs were held with policy-level stakeholders. Participants included stakeholders from both the Ugandan government and non-governmental organizations. Utilizing a thematic approach, themes around motivation, job satisfaction, incentive preferences, and CHW relationships with the community, healthcare facilities, and government were analyzed. Results: CHWs identified a range of factors that contributed to their motivation or demotivation. Non-monetary factors included recognition from the health system and community, access to transportation, methods for identification as a healthcare worker, provision of working tools, and training opportunities. Monetary factors included access to monthly stipends, transportation-related refunds, and timely payment systems to reduce refund delays to CHWs. Additionally, CHWs indicated wanting to be considered for recruitment into the now-halted rollout of a salaried CHW cadre, given the provision of payment. Conclusion: It is imperative to consider how to best support the current CHW program prior to the introduction of new cadres, as it can serve to exacerbate tensions between cadres and further undermine provision of community health. Providing a harmonized, balanced, and uniform combination of both monetary incentives with non-monetary incentives is vital for effective CHW programs.

A systematic review of the types, workload, and supervision mechanism of community health workers: lessons learned for Indonesia

“…• Most CHWs have more than three responsibilities for disease prevention programme (generalist CHWs) [ 17 , 26 , 30 , 32 , 40 , 41 , 44 , 45 ]…”

The Effects of Monetary Incentives on Physicians’ Effort and Patient Satisfaction: Understanding the Links between Monetary Incentives and Physicians’ Effort

“…As mentioned above, the physicians would put effort into the three dimensions to improve patients’ satisfaction. During the COVID-19 pandemic, medical staff are under significant occupational pressure, and monetary incentives can not only promote patients’ satisfaction and alleviate the current stage of doctor–patient conflict caused by the shortage of medical resource, but also improve the salary level of medical staff through monetary incentives, which usually cannot be modified due to policy governance, and promote physicians’ work satisfaction [ 16 , 26 ].…”

Exploring Community Resilience in Disaster Risk Reduction Among Coastal Communities in Kilifi County

“…Further, most of the attention goes to 'intensive' disasters like earthquakes and cyclones, but the cumulative damage, particularly to the poor, posed by 'extensive' disasters such as drought, soil erosion, and persistent flooding, is often not given the needed attention (Steiner & Markantoni,2014). Thus, targeting the poor and the vulnerable as the face of resilience building through appropriate disaggregated poverty mapping in an integrated manner has been found as one of the strategies suggested by these international protocols and convention (Abuya & Mwanga, 2022).…”