Abstract
BackgroundAttrition of community health workers (CHWs) continues to threaten the full realisation and sustainability of community-based health programmes globally.AimThis study aimed to understand factors associated with CHWs’ recruitment and their retention.SettingThis study was conducted in five districts of the Simiyu Region, namely, Bariadi, Busega, Itilima, Maswa and Meatu in north-western Tanzania.MethodsIn this cross-sectional study design, 341 CHWs who were working with the maternal health programme were randomly selected. Semi-structured questionnaires were administered to all participants. Data were descriptively and inferentially analysed using SPSS version 20.ResultsMajority (58.0%) of CHWs were below 35 years. Over half (53.1%) had completed primary education only. Motivation factors for being CHW were aspiration to serve the community and desire for further training to become a qualified medical practitioner. Community recognition and financial incentives were among the key retention reasons for the CHWs. Being married (odds ratio [OR] 5.9, 95% confidence interval [CI] 1.7–20.1) having prior volunteer experience (OR 10.5 95% CI 12.7–40.5) and prior employment OR 21.8 (CI 12.2–38.9) were positively associated with retention of CHWs, while being a female was negatively associated with retention OR 0.4 (CI 0.2–0.8).ConclusionsBoth financial and non-financial incentives were critical in contributing to the retention of CHWs. Thus, health programmes should carefully select CHWs by understanding their motives beforehand, and provide them with incentives.
Highlights
The dearth of human resources for health (HRH) coupled with high maternal and child mortality in low-and middle-income countries has necessitated an increased interest in the use of community health workers (CHWs) to improve health outcomes.[1]
A CHW is a member of the community who has not been formally trained as a clinician and has been chosen by his or her community to promote or provide health care services in the same community following a structured short-term period of training.[2]
Over the past three decades, a number of studies have shown that CHWs can help to reduce morbidity and mortality related to HIV and AIDS, malaria and tuberculosis.[3,4,5,6,7,8,9,10,11,12,13]
Summary
The dearth of human resources for health (HRH) coupled with high maternal and child mortality in low-and middle-income countries has necessitated an increased interest in the use of community health workers (CHWs) to improve health outcomes.[1]. Studies from Kenya, Nigeria, Bangladesh, India and Indonesia have showed that CHWs contributed to the reduction of maternal, neonatal and child mortality through antenatal care uptake, anti-tetanus vaccination coverage during pregnancy and increasing deliveries within health facilities. Community health workers increased the number of women breastfeeding within the first 24 h, number of newborns checked by health workers within 48 h and increased the knowledge of specific newborn danger signs among mothers.[15,17,18,19,20] Because of these successes, many countries in sub-Saharan Africa and Southeast Asia are planning, implementing and scaling up CHW programmes at the national level. Attrition of community health workers (CHWs) continues to threaten the full realisation and sustainability of community-based health programmes globally
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