Abstract

BackgroundCommunity health worker motivation is an important consideration for improving performance and addressing maternal, newborn, and child health in low and middle-income countries. Therefore, identifying health system interventions that address motivating factors in resource-strained settings is essential. This study is part of a larger implementation research project called Nigraan, which is intervening on supportive supervision in the Lady Health Worker Programme to improve community case management of pneumonia and diarrhea in rural Pakistan. This study explored the motivation of Lady Health Supervisors, a cadre of community health workers, with particular attention to their views on supportive supervision.MethodsTwenty-nine lady health supervisors enrolled in Nigraan completed open-ended structured surveys with questions exploring factors that affect their motivation. Thematic analysis was conducted using a conceptual framework categorizing motivating factors at individual, community, and health system levels.ResultsSupportive supervision, recognition, training, logistics, and salaries are community and health system motivating factors for lady health supervisors. Lady health supervisors are motivated by both their role in providing supportive supervision to lady health workers and by the supervisory support received from their coordinators and managers. Family support, autonomy, and altruism are individual level motivating factors.ConclusionsHealth system factors, including supportive supervision, are crucial to improving lady health supervisor motivation. As health worker motivation influences their performance, evaluating the impact of health system interventions on community health worker motivation is important to improving the effectiveness of community health worker programs.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1641-x) contains supplementary material, which is available to authorized users.

Highlights

  • Community health worker motivation is an important consideration for improving performance and addressing maternal, newborn, and child health in low and middle-income countries

  • [We feel happy] when the community admires our work related to diarrhea, pneumonia, and vaccination in the field. (LHS 7)

  • Lady Health Supervisor (LHS) in this study added insight to the complex portfolio of motivating and demotivating factors experienced while working for the Lady Health Worker (LHW)-P in Pakistan

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Summary

Introduction

Community health worker motivation is an important consideration for improving performance and addressing maternal, newborn, and child health in low and middle-income countries. CHW motivation, often categorized into individual, community, and health system levels [5, 6], is important to the efficiency of healthcare delivery in LMICs [1, 7, 8]. This is because health worker motivation considerably influences performance and productivity as reflected by health worker commitment and readiness to use their knowledge and skills to fulfill their responsibilities [8, 9]. CHWs from various LMICs have described increased social status as healthcare providers and educators to be a motivating factor [10,11,12,13,14, 18, 20]

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