Qualitative assessment of community health workers’ perspective on their motivation in community-based primary health care in rural Malawi

Abstract

Background Community Health Workers (CHWs) have a positive impact on the provision of community-based primary health care through screening, treatment, referral, psychosocial support, and accompaniment. With a broad scope of work, CHW programs must balance the breadth and depth of tasks to maintain CHW motivation for high-quality care delivery. Few studies have described the CHW perspective on intrinsic and extrinsic motivation to enhance their programmatic activities. Methods We utilized an exploratory qualitative study design with CHWs employed in the household model in Neno District, Malawi, to explore their perspectives on intrinsic and extrinsic motivators and dissatisfiers in their work. Data was collected in 8 focus group discussions with 90 CHWs in October 2018 and March–April 2019 in seven purposively selected catchment areas. All interviews were audiotaped, transcribed verbatim, coded, and analyzed using Dedoose. Results Themes of complex intrinsic and extrinsic factors were generated from the perspectives of the CHWs in the focus group discussions. Study results indicate that enabling factors are primarily intrinsic factors such as positive patient outcomes, community respect, and recognition by the formal health care system but can lead to the challenge of increased scope and workload. Extrinsic factors can provide challenges, including an increased scope and workload from original expectations, lack of resources to utilize in their work, and rugged geography. However, a positive work environment through supportive relationships between CHWs and supervisors enables the CHWs. Conclusion This study demonstrated enabling factors and challenges for CHW performance from their perspective within the dual-factor theory. We can mitigate challenges through focused efforts to limit geographical distance, manage workload, and strengthen CHW support to reinforce their recognition and trust. Such programmatic emphasis can focus on enhancing motivational factors found in this study to improve the CHWs’ experience in their role. The engagement of CHWs, the communities, and the formal health care system is critical to improving the care provided to the patients and communities, along with building supportive systems to recognize the work done by CHWs for the primary health care systems.

The Primary Healthcare Physician's Awareness and Engagement in Community-Based Medical Education: a mixed qualitative and quantitative study

“…These findings, consistent with the study, indicated that the engagement of primary healthcare in community-based medical education is crucial for developing competent and compassionate healthcare professionals [20]. Ndambo, 2022 showed that engaging primary healthcare providers in community-based medical education also benefits the providers themselves [21]. The impact of training in increasing the engagement of primary healthcare in community-based medical education was confirmed by [22][23][24].…”

Frontline workers' performance in prosocial tasks: evidence from a Lab-in-the-Field in Western India

“…According to this argument, the organization's mission and the absence of incentives can enable individuals to self-select into care roles and perform driven by a public benefit motive. The argument of lower incentives as a self-selection strategy is also seen in the context of CHS literature (Mallari et al ., 2020; Ndambo et al ., 2022).…”

A time-motion study of community health workers delivering community-based primary health care in Neno District, Malawi

“…The CHWs are given a volunteer stipend (38 USD) for time and transport, provided training and ongoing education and support, and service delivery tools such as ip charts. CHWs work within the Ministry of Health's community health structure and alongside Health Surveillance Assistants (HSAs), community health care workers based at facilities in Malawi [11,26]. HSAs supervise community activities, village clinics, immunization, and household-level care but are signi cantly understaffed and overworked within the healthcare system [26].…”

“…Generally, CHWs do not have professional training but are locally trained in the context of the speci c intervention and primary care system and are chosen from the community they serve [5]. Ample literature demonstrates that CHWs contribute positively to primary health care with improved health outcomes, especially in remote and poor communities [2,[6][7][8][9][10][11][12][13][14][15].…”

“…While there is no literature on the scope and workload of speci c programs, several studies in sub-Saharan Africa, including Malawi, demonstrate that an increased number of households assigned to the CHW results in underperformance, dissatisfaction, and poor retention [11,[21][22][23][24][25][26][27][28][29]. With the increased workload, studies have shown that CHWs may select tasks that they prefer to do, especially ones they do best and or require less effort [4,30,31].…”