Using a human resource management approach to support community health workers: experiences from five African countries

Abstract

BackgroundLike any other health worker, community health workers (CHWs) need to be supported to ensure that they are able to contribute effectively to health programmes. Management challenges, similar to those of managing any other health worker, relate to improving attraction, retention and performance.MethodsExploratory case studies of CHW programmes in the Democratic Republic of Congo, Ghana, Senegal, Uganda and Zimbabwe were conducted to provide an understanding of the practices for supporting and managing CHWs from a multi-actor perspective. Document reviews (n = 43), in-depth interviews with programme managers, supervisors and community members involved in managing CHWs (n = 31) and focus group discussions with CHWs (n = 13) were conducted across the five countries. Data were transcribed, translated and analysed using the framework approach.ResultsCHWs had many expectations of their role in healthcare, including serving the community, enhancing skills, receiving financial benefits and their role as a CHW fitting in with their other responsibilities. Many human resource management (HRM) practices are employed, but how well they are implemented, the degree to which they meet the expectations of the CHWs and their effects on human resource (HR) outcomes vary across contexts. Front-line supervisors, such as health centre nurses and senior CHWs, play a major role in the management of CHWs and are central to the implementation of HRM practices. On the other hand, community members and programme managers have little involvement with managing the CHWs.ConclusionsThis study highlighted that CHW expectations are not always met through HRM practices. This paper calls for a coordinated HRM approach to support CHWs, whereby HRM practices are designed to not only address expectations but also ensure that the CHW programme meets its goals. There is a need to work with all three groups of management actors (front-line supervisors, programme managers and community members) to ensure the use of an effective HRM approach. A larger multi-country study is needed to test an HRM approach that integrates context-appropriate strategies and coordinates relevant management actors. Ensuring that CHWs are adequately supported is vital if CHWs are to fulfil the critical role that they can play in improving the health of their communities.

Community Health Volunteers in Primary Healthcare in Rural Uganda: Factors Influencing Performance

“…Some of these have been identified as being significant factors in motivation of CHVs (13, 14, 17, 18, 25, 26). …”

“…Individual, group, and program factors have each been shown to influence the performance of CHVs (1, 3, 5, 6, 8–15, 17–19, 25). Factors previously reported to result into improved performance include the female gender, regular supervision and provision of feedback, higher education, the availability of job aides and other tools, and feeling “connected” with the system (3, 5, 6, 9–11, 13, 14, 17, 18).…”

Global-local divides and ontological politics: feminist STS perspectives on mobile learning for community health workers in Kenya

“…These Millennium Development Goals comprised the backbone of what was described as 'an unprecedented agreementamong developed countries, developing countries, and international agenciesto work towards a world in which sustaining development and eliminating poverty would have highest priority ' (World Bank 2003, 7). In this context, training interventions were aimed at enhancing a CHW's performance as an instrument of these widely-endorsed health policies, rather than promoting learning outcomes per se (see Hongoro and McPake 2004;Raven et al 2015).…”

Maternal and newborn health implementation research: programme outcomes, pathways of change and partnerships for equitable health systems in Uganda

“…Research on CHWs in other contexts has also supported innovations in CHW supervision going beyond their facility-based supervisors [27][28][29]. MANIFEST also found that non-monetary incentives such as T-shirts, certificates and musawo (doctor) status in the community motivated VHTs to continue working.…”