Factors influencing motivation and job satisfaction among supervisors of community health workers in marginalized communities in South Africa

Abstract

BackgroundManagement and supervision of community health workers are factors that are critical to the success of community health worker programmes. Yet few studies have explored the perspectives of supervisors in these programmes. This study explored factors influencing motivations of supervisors in community health worker programmes.MethodsWe conducted qualitative interviews with 26 programme staff providing supervision to community health workers in eight community-based organizations in marginalized communities in the greater Durban area of South Africa from July 2010 to September 2011.ResultsFindings show that all the supervisors had previous experience working in the health or social services sectors and most started out as unpaid community health workers. Most of the participants were poor women from marginalized communities. Supervisors’ activities include the management and supply of material resources, mentoring and training of community health workers, record keeping and report writing. Supervisors were motivated by intrinsic factors like making a difference and community appreciation and non-monetary incentives such as promotion to supervisory positions; acquisition of management skills; participation in capacity building and the development of programmes; and support for educational advancement like salary, bonuses and medical benefits. Hygiene factors that serve to prevent dissatisfaction are salaries and financial, medical and educational benefits attached to the supervisory position. Demotivating factors identified are patients’ non-adherence to health advice and alienation from decision-making. Dissatisfiers include working in crime-prevalent communities, remuneration for community health workers (CHWs), problems with material and logistical resources, job insecurity, work-related stressors and navigating the interface between CHWs and management. While participants were dissatisfied with their low remuneration, they were not demotivated but continued to be motivated by intrinsic factors. Our findings suggest that CHWs’ quest for remuneration and a career path continues even after they assume supervisory positions. Supervisors continue to be motivated to work in mid-level positions within the health and social services sectors.ConclusionsGlobal efforts to develop and increase the sustainability of CHW programmes will benefit immensely from insights gained from an exploration of supervisors’ perspectives. Further, national CHW programmes should be conceptualized with the dual purpose of building the capacity of CHWs to strengthen health systems and reducing unemployment especially in marginalized communities with high unemployment and low-skilled labour force.

Perceptions of community health workers on their training, teamwork and practice: a cross-sectional study in Tshwane district, Gauteng, South Africa.

“…22 A study by Akintola and Chikoko in Durban found that promotion to supervisory position was cited as one of the factors that motivated CHWs who started as unpaid volunteers and acquired experience on the job. 23 The sex of CHWs has been shown to 24 However, a study by Razee et al (2012) in Papua New Guinea reported that a perceived lack of safety among female CHWs affected motivation to work and resulted in some resigning. 25 In this study, the majority (93%) of CHWs had received training; 76.3% perceived that the training was adequate and 85.8% were confident in performing their duties.…”

Community health worker perspectives on a new primary health care initiative in the Eastern Cape of South Africa

“…While barriers and facilitators to the scale-up and integration of CHWs have been studied in multiple contexts, the perspective of CHWs themselves has not been frequently explored [20–24]. …”

Local-level challenges to implementing health education programs in rural settings: a qualitative study

“…Both the RHWs and the clients reported low engagement in health education programs, due to the less motivation to carry out the health education programs and the few demand needed for health information, respectively. The role of the management system in motivating community health workers has been demonstrated in numerous previous studies [18,19]. The findings of a study conducted in the north of Vietnam among health workers indicated that the motivation of RHWs was influenced by both financial and non-financial incentives, and one of the main motivating factors for them was appreciation by managers, colleagues and the community [20].…”