Motivation and Performance of Community Health Workers: Nothing New Under the Sun, and Yet…

Sarriot, Eric; Davis, Thomas W.; Morrow, Melanie; Kabore, Telesphore; Perry, Henry B.

doi:10.9745/ghsp-d-21-00627

Cited by 10 publications

(7 citation statements)

References 49 publications

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“…Modest financial incentives were not a major motivator for CHWs in our study in contrast to many other studies 20 26 57–59. However, they became more influential as the size of the incentive rose, particularly for the volunteer CHWs.…”

Section: Discussioncontrasting

confidence: 92%

It is not all about salary: a discrete-choice experiment to determine community health workers’ motivation for work in Nigeria

et al. 2022

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IntroductionCommunity health workers (CHWs) constitute the majority of primary healthcare (PHC) workers in Nigeria, yet little is understood about their motivations or the most effective interventions to meet their needs to ensure quality health coverage across the country. We aimed to identify factors that would motivate CHWs for quality service delivery.MethodsA discrete-choice experiment was conducted among 300 CHWs across 44 PHC facilities in the Federal Capital Territory, Abuja Nigeria. Based on the literature review and qualitative research, five attributes, namely: salary, educational opportunities, career progression and in-service training, housing and transportation, were included in the experiment. CHWs were presented with 12 unlabelled choice sets, using tablet devices, and asked to choose which of two hypothetical jobs they would accept if offered to them, or whether they would take neither job. Mixed multinomial logistic models were used to estimate stated preferences for the attributes and the likely uptake of jobs under different policy packages was simulated.ResultsAbout 70% of the respondents were women and 39% worked as volunteers. Jobs that offered career progression were the strongest motivators among the formally employed CHWs (β=0.33) while the ‘opportunity to convert from CHW to another cadre of health workers, such as nursing’ was the most important motivator among the volunteers’ CHWs (β=0.53). CHWs also strongly preferred jobs that would offer educational opportunities, including scholarship (β=0.31) and provision of transport allowances (β=0.26). Policy scenario modelling predicted combined educational opportunities, career progression opportunities and an additional 10% of salary as incentives was the employment package that would be most appealing to CHWs.ConclusionCHWs are motivated by a mix of non-financial and financial incentives. Policy interventions that would improve motivation should be adequate to address various contexts facing different CHWs and be flexible enough to meet their differing needs.

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Section: Discussioncontrasting

confidence: 92%

It is not all about salary: a discrete-choice experiment to determine community health workers’ motivation for work in Nigeria

et al. 2022

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“…As such, implementers of this model—may wish to seek out AGYW who are: (1) deeply concerned that their friends are at imminent risk of acquiring HIV, and (2) have high intrinsic motivation to intervene, as this may help them follow through with the target behaviors even when doing so poses potential social risks for them (e.g., damage to their friendships and/or reputation). This finding resonates with literature on other lay provider models ( 45 ), which has found that a sense of purpose is critical to motivating uptake and sustained use of target behaviors.…”

Section: Discussionsupporting

confidence: 86%

Assessing young Kenyan women's willingness to engage in a peer-delivered HIV self-testing and referral model for PrEP initiation: A qualitative formative research study

McGowan

Casmir

Wairimu

et al. 2022

Front. Public Health

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BackgroundPre-exposure prophylaxis (PrEP) is highly effective for HIV prevention, but uptake remains low, especially among adolescent girls and young women (AGYW) in Kenya. A model in which trained AGYW using PrEP deliver HIV self-tests to their close friends and refer them to PrEP may help increase PrEP uptake in this population. To understand AGYW's potential willingness to engage in such a model, we conducted a qualitative formative study in Kenya.MethodWe conducted semi-structured in-depth interviews (IDIs) with AGYW (16 to 24 years) in Kiambu County who were determined at risk of HIV acquisition. We purposively recruited “PrEP-naïve” (no prior PrEP use) and “PrEP-experienced” AGYW who used PrEP for at least 1 month within the previous year. We solicited perspectives on initiating/engaging in conversations about HIV risk and PrEP, distributing/receiving HIV self-test kits, and referring/following through on a referral to clinic-based HIV services. We analyzed verbatim transcripts using rapid qualitative analysis and a combination of inductive and deductive approaches, with the latter informed by the Integrated Behavior Model (IBM).ResultsFrom August to December 2020, we conducted 30 IDIs: 15 with PrEP-experienced and 15 with PrEP-naïve AGYW. Participants' median age was 20 [interquartile range (IQR): 20–22]. Overall, most participants anticipated that they would be willing to engage in this model. PrEP-experienced AGYW emphasized the salience of their concerns about friends' HIV risk behaviors, with several noting that they are already in the habit of discussing PrEP with friends. Many additionally expressed positive attitudes toward the proposed target behaviors, perceived these to be normative among AGYW, and expressed confidence in their ability to carry out the behaviors with proper support. Although few participants had HIVST experience, nearly all anticipated they would be able to use an HIV self-test kit correctly if provided instruction.ConclusionThe Kenyan AGYW who participated in this study generally anticipated that they would be willing to engage in a formal peer PrEP referral model enhanced with peer-delivered HIV self-tests. Future research is needed to pilot test this model to determine its acceptability, feasibility, and effect on HIVST and PrEP uptake within this population.

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“…Community Health Committee members, therefore, expect to be remunerated for their participation 73 . This finding adds to the debate on the provision of financial incentives for community members volunteering in the delivery and oversight of community health services 74,75 …”

Section: Discussionmentioning

confidence: 97%

“…73 This finding adds to the debate on the provision of financial incentives for community members volunteering in the delivery and oversight of community health services. 74,75 The transfer of responsibility for managing health care services from the national MoH to devolved sub-national units (counties) had a cross-cutting effect on the overall functionality of CHCs. Counties, where we conducted our study, have demonstrated limited commitment to providing operational support (capacity building, supervision, incentives, etc.)…”

Section: Discussionmentioning

confidence: 99%

How context influences the functionality of community‐level health governance structures: A case study of community health committees in Kenya

Karuga

Kok

Mbindyo

et al. 2023

Health Planning & Management

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Community Health Committees (CHCs) are mechanisms through which communities participate in the governance and oversight of community health services. While there is renewed interest in strengthening community participation in the governance of community health services, there is limited evidence on how context influences community‐level structures of governance and oversight. The objective of this study was to examine how contextual factors influence the functionality of CHCs in Kajiado, Migori, and Nairobi Counties in Kenya. Using a case study design, we explored the influence of context on CHCs using 18 focus group discussions with 110 community members (clients, CHC members, and community health volunteers [CHVs]) and interviews with 33 health professionals. Essential CHC functions such as ‘leadership’ and ‘management’ were weak, partly because Health professionals did not involve CHCs in developing health plans. Community Health Committees were active in the supervision of CHVs, reviewing their household reports, although they did not utilise these data for making decisions. Resource mobilisation and evaluation of health programs were affected by the lack of administrative and operational support, such as training. Despite having influential membership, CHCs could not provide leadership and management functions. Health system actors perceived the roles of CHCs as service providers rather than structures for governance and oversight. Insufficient awareness of CHC roles among health professionals, lack of training and operational support for community‐based activities constrained CHCs' functionality and thus their role in community participation. While there are efforts to institutionalise community‐level governance structures for health at sub‐national level, there is a need to scale‐up these efforts countrywide. We recommend that community‐level governance structures be empowered, mandated, and provided with resources to take on the responsibility of overseeing community health services and exacting accountability from health providers.

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Motivation and Performance of Community Health Workers: Nothing New Under the Sun, and Yet…

Abstract: We know that both financial and nonfinancial incentives matter if we want community health workers (CHWs) who are motivated and performing. What are the practical implications for CHWs themselves and for effective management of viable CHW programs?

Cited by 10 publications

References 49 publications

It is not all about salary: a discrete-choice experiment to determine community health workers’ motivation for work in Nigeria

It is not all about salary: a discrete-choice experiment to determine community health workers’ motivation for work in Nigeria

Assessing young Kenyan women's willingness to engage in a peer-delivered HIV self-testing and referral model for PrEP initiation: A qualitative formative research study

How context influences the functionality of community‐level health governance structures: A case study of community health committees in Kenya

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