Staff attrition among community health workers in home-based care programmes for people living with HIV and AIDS in western Kenya

Olango, C.; Nyamongo, Isaac K.; Aagaard‐Hansen, Jens

doi:10.1016/j.healthpol.2010.05.004

Cited by 67 publications

(70 citation statements)

References 5 publications

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“…The findings of our study on supervisors support the findings of previous studies exploring the motivation of CHWs [2, 11, 15, 17, 19]. It demonstrates that many of our study participants were promoted from CHWs to supervisor positions, and this fulfils their motivations to secure paid jobs.…”

Section: Discussionsupporting

confidence: 88%

“…Globally, studies among CHWs identify attrition as a major factor undermining the sustainability of CHW programmes [2, 17–19]. Recent studies on CHWs in South Africa have highlighted the link between CHW motivations and attrition, and a number of studies have sought to gain deeper and more nuanced understanding of CHW motivations and factors influencing sustained volunteer CHW motivations in order to better inform policies intended to address the problem of CHW attrition [11, 17].…”

Section: Discussionmentioning

confidence: 99%

“…Research has found that the main factors motivating CHWs are altruism, religious and moral obligations, the prospects of paid employment in the health and social services sector, previous experience with HIV and AIDS in the family, and the wish to avoid idleness [10, 11, 17]. Studies have also identified supervision as a key factor influencing retention among CHWs [18, 19]. CHWs participating in a recent study in Mozambique indicated that they felt demotivated by the supervision provided because it was infrequent and irregular and focussed on fault finding [16].…”

Section: Introductionmentioning

confidence: 99%

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

Akintola

Chikoko

2016

Hum Resour Health

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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.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Akintola

Chikoko

2016

Hum Resour Health

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“…Eighteen months after the KMNCH team finished training in Eburru, retention was more than 80%. These retention rates are higher than those reported in other Kenyan studies where drop out rates of 33%–40% were noted [15], [19]. The potential impact of curriculum timing and spacing on retention rates is an area ripe for future qualitative and quantitative research.…”

Section: Discussionmentioning

confidence: 56%

Improving Maternal and Newborn Health: Effectiveness of a Community Health Worker Program in Rural Kenya

et al. 2014

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BackgroundVolunteer community health workers (CHWs) form an important element of many health systems, and in Kenya these volunteers are the foundation for promoting behavior change through health education, earlier case identification, and timely referral to trained health care providers. This study examines the effectiveness of a community health worker project conducted in rural Kenya that sought to promote improved knowledge of maternal newborn health and to increase deliveries under skilled attendance.MethodsThe study utilized a quasi-experimental nonequivalent design that examined relevant demographic items and knowledge about maternal and newborn health combined with a comprehensive retrospective birth history of women’s children using oral interviews of women who were exposed to health messages delivered by CHWs and those who were not exposed. The project trained CHWs in three geographically distinct areas.ResultsMean knowledge scores were higher in those women who reported being exposed to the health messages from CHWs, Eburru 32.3 versus 29.2, Kinale 21.8 vs 20.7, Nyakio 26.6 vs 23.8. The number of women delivering under skilled attendance was higher for those mothers who reported exposure to one or more health messages, compared to those who did not. The percentage of facility deliveries for women exposed to health messages by CHWs versus non-exposed was: Eburru 46% versus 19%; Kinale 94% versus 73%: and Nyakio 80% versus 78%.ConclusionThe delivery of health messages by CHWs increased knowledge of maternal and newborn care among women in the local community and encouraged deliveries under skilled attendance.

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“…One major issue plaguing community and lay health worker programs is high levels of attrition resulting from resignations, terminations, or relocations [2,4,12], leaving the few enthusiastic and reliable lay workers that remain to become overloaded with work [13–15]. Attrition rates have been reported of up to 30% over 9 months in Senegal and 50% over 2 years in Nigeria [16], while Olang'o et al report an attrition rate of 33% among home-based care community health workers in western Kenya [17]. Furthermore, although community-based lay health workers can be volunteers [18], in practice most are financially rewarded, while there are hardly any examples of sustained community financing in low- or middle-income contexts [19].…”

Section: Introductionmentioning

confidence: 99%

The Influence of Community Health Resources on Effectiveness and Sustainability of Community and Lay Health Worker Programs in Lower-Income Countries: A Systematic Review

Vries

Pool

2017

PLoS ONE

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BackgroundDespite the availability of practical knowledge and effective interventions required to reduce priority health problems in low-income countries, poor and vulnerable populations are often not reached. One possible solution to this problem is the use of Community or Lay Health Workers (CLHWs). So far, however, the development of sustainability in CLHW programs has failed and high attrition rates continue to pose a challenge. We propose that the roles and interests which support community health work should emerge directly from the way in which health is organized at community level. This review explores the evidence available to assess if increased levels of integration of community health resources in CLHW programs indeed lead to higher program effectiveness and sustainability.Methods and FindingsThis review includes peer-reviewed articles which meet three eligibility criteria: 1) specific focus on CLHWs or equivalent; 2) randomized, quasi-randomized, before/after methodology or substantial descriptive assessment; and 3) description of a community or peer intervention health program located in a low- or middle-income country. Literature searches using various article databases led to 2930 hits, of which 359 articles were classified. Of these, 32 articles were chosen for extensive review, complemented by analysis of the results of 15 other review studies. Analysis was conducted using an excel based data extraction form. Because results showed that no quantitative data was published, a descriptive synthesis was conducted. The review protocol was not proactively registered. Findings show minimal inclusion of even basic community level indicators, such as the degree to which the program is a community initiative, community input in the program or training, the background and history of CLHW recruits, and the role of the community in motivation and retention. Results show that of the 32 studies, only one includes one statistical measure of community integration. As a result of this lack of data we are unable to derive an evidence-based conclusion to our propositions. Instead, our results indicate a larger problem, namely the complete absence of indicators measuring community relationships with the programs studied. Studies pay attention only to gender and peer roles, along with limited demographic information about the recruits. The historicity of the health worker and the community s/he belongs to is absent in most studies reviewed. None of the studies discuss or test for the possibility that motivation emanates from the community. Only a few studies situate attrition and retention as an issue enabled by the community. The results were limited by a focus on low-income countries and English, peer-reviewed published articles only.ConclusionPublished, peer-reviewed studies evaluating the effectiveness and sustainability of CLHW interventions in health programs have not yet adequately tested for the potential of utilizing existing community health roles or social networks for the development of effective and sus...

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Staff attrition among community health workers in home-based care programmes for people living with HIV and AIDS in western Kenya

Cited by 67 publications

References 5 publications

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

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

Improving Maternal and Newborn Health: Effectiveness of a Community Health Worker Program in Rural Kenya

The Influence of Community Health Resources on Effectiveness and Sustainability of Community and Lay Health Worker Programs in Lower-Income Countries: A Systematic Review

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