TY - JOUR
T1 - Sources of community health worker motivation
T2 - A qualitative study in Morogoro Region, Tanzania
AU - Greenspan, Jesse A.
AU - McMahon, Shannon A.
AU - Chebet, Joy J.
AU - Mpunga, Maurus
AU - Urassa, David P.
AU - Winch, Peter J.
N1 - Funding Information:
Portions of this manuscript were presented at the 1st MUHAS Scientific Conference in Dar-es-Salaam, Tanzania in May 2013. This research was funded by the United States Agency for International Development (USAID) through the Health Research Challenge for Implementation (HRCI) cooperative agreement. The National Institute of Mental Health of the National Institutes of Health supported co-author Shannon McMahon (Award F31MH095653). The content is solely the responsibility of the authors and does not necessarily represent the official views of USAID or the National Institutes of Health. The authors would like to acknowledge the community health workers who gave their time to be interviewed; the qualitative data collection team who conducted and transcribed interviews, including Mr. Amrad Charles, Mr. Emmanuel Massawe, Ms. Rozalia Mtaturo, and Ms. Zaina Sheweji; the MUHAS-based team consisting of Prof. Japhet Killewo (PI), Dr. Switbert Kamazima, Dr. Charles Kilewo, Ms. Idda Mosha, Dr. Rose Mpembeni, Ms. Aisha Omary, and Mr. Deogratias Maufi; the Jhpiego-based team consisting of Ms. Maryjane Lacoste, Dr. Chrisostom Lipingu, Dr. Miriam Kombe, Ms. Elaine Charurat, Ms. Chelsea Cooper; and the JHSPH-based team consisting of Dr. Abdullah Baqui (PI), Ms. Carla Blauvelt, Dr. Jennifer Callaghan, Dr. Asha George, Dr. Shivam Gupta, Dr. Amnesty LeFevre, Ms. Nicola Martin, and Dr. Diwakar Mohan. The authors would like to thank Peggy Gross of Johns Hopkins University for her advice on the literature search and Prof. Killewo, Dr. George, and Dr. LeFevre for their contributions to editing the paper.
PY - 2013/10/10
Y1 - 2013/10/10
N2 - Background: There is a renewed interest in community health workers (CHWs) in Tanzania, but also a concern that low motivation of CHWs may decrease the benefits of investments in CHW programs. This study aimed to explore sources of CHW motivation to inform programs in Tanzania and similar contexts.Methods: We conducted semi-structured interviews with 20 CHWs in Morogoro Region, Tanzania. Interviews were digitally recorded, transcribed, and coded prior to translation and thematic analysis. The authors then conducted a literature review on CHW motivation and a framework that aligned with our findings was modified to guide the presentation of results.Results: Sources of CHW motivation were identified at the individual, family, community, and organizational levels. At the individual level, CHWs are predisposed to volunteer work and apply knowledge gained to their own problems and those of their families and communities. Families and communities supplement other sources of motivation by providing moral, financial, and material support, including service fees, supplies, money for transportation, and help with farm work and CHW tasks. Resistance to CHW work exhibited by families and community members is limited. The organizational level (the government and its development partners) provides motivation in the form of stipends, potential employment, materials, training, and supervision, but inadequate remuneration and supplies discourage CHWs. Supervision can also be dis-incentivizing if perceived as a sign of poor performance.Conclusions: Tanzanian CHWs who work despite not receiving a salary have an intrinsic desire to volunteer, and their motivation often derives from support received from their families when other sources of motivation are insufficient. Policy-makers and program managers should consider the burden that a lack of remuneration imposes on the families of CHWs. In addition, CHWs' intrinsic desire to volunteer does not preclude a desire for external rewards. Rather, adequate and formal financial incentives and in-kind alternatives would allow already-motivated CHWs to increase their commitment to their work.
AB - Background: There is a renewed interest in community health workers (CHWs) in Tanzania, but also a concern that low motivation of CHWs may decrease the benefits of investments in CHW programs. This study aimed to explore sources of CHW motivation to inform programs in Tanzania and similar contexts.Methods: We conducted semi-structured interviews with 20 CHWs in Morogoro Region, Tanzania. Interviews were digitally recorded, transcribed, and coded prior to translation and thematic analysis. The authors then conducted a literature review on CHW motivation and a framework that aligned with our findings was modified to guide the presentation of results.Results: Sources of CHW motivation were identified at the individual, family, community, and organizational levels. At the individual level, CHWs are predisposed to volunteer work and apply knowledge gained to their own problems and those of their families and communities. Families and communities supplement other sources of motivation by providing moral, financial, and material support, including service fees, supplies, money for transportation, and help with farm work and CHW tasks. Resistance to CHW work exhibited by families and community members is limited. The organizational level (the government and its development partners) provides motivation in the form of stipends, potential employment, materials, training, and supervision, but inadequate remuneration and supplies discourage CHWs. Supervision can also be dis-incentivizing if perceived as a sign of poor performance.Conclusions: Tanzanian CHWs who work despite not receiving a salary have an intrinsic desire to volunteer, and their motivation often derives from support received from their families when other sources of motivation are insufficient. Policy-makers and program managers should consider the burden that a lack of remuneration imposes on the families of CHWs. In addition, CHWs' intrinsic desire to volunteer does not preclude a desire for external rewards. Rather, adequate and formal financial incentives and in-kind alternatives would allow already-motivated CHWs to increase their commitment to their work.
KW - Community health workers
KW - Incentives
KW - Motivation
KW - Tanzania
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U2 - 10.1186/1478-4491-11-52
DO - 10.1186/1478-4491-11-52
M3 - Article
C2 - 24112292
AN - SCOPUS:84885125624
SN - 1478-4491
VL - 11
JO - Human resources for health
JF - Human resources for health
IS - 1
M1 - 52
ER -