Motivation and satisfaction among community health workers in Morogoro Region, Tanzania: nuanced needs and varied ambitions.

Rose N M Mpembeni,Aarushi Bhatnagar,Asha George,David P Urassa,Dereck Chitama,Japhet Killewo,Rebecca M Mdee,Abdullah H Baqui,Amnesty Lefevre,Peter J Winch,Charles Kilewo,Helen Semu

doi:10.1186/s12960-015-0035-1

Abstract

BackgroundIn 2012, the Ministry of Health and Social Welfare (MOHSW), Tanzania, approved national guidelines and training materials for community health workers (CHWs) in integrated maternal, newborn and child health (Integrated MNCH), with CHWs trained and deployed across five districts of Morogoro Region soon after. To inform future scale up, this study assessed motivation and satisfaction among these CHWs.MethodsA survey of all CHWs trained by the Integrated MNCH Programme was conducted in the last quarter of 2013. Motivation and satisfaction were assessed using a five-point Likert scale with 29 and 27 items based on a literature review and discussions with CHW programme stakeholders. Exploratory factor analysis was conducted to identify motivation and satisfaction determinants.ResultsOut of 238 eligible CHWs, 96 % were included in the study. Findings showed that respondents were motivated to become CHWs due to altruism (work on MNCH, desire to serve God, work hard) and intrinsic needs (help community, improve health, pride) than due to external stimuli (monetary incentives, skill utilization, community respect or hope for employment). CHWs were satisfied by relationships with health workers and communities, job aids and the capacity to provide services. CHWs were dissatisfied with the lack of transportation, communication devices and financial incentives for carrying out their tasks. Factors influencing motivation and satisfaction did not differ across CHW socio-demographic characteristics. Nonetheless, older and less educated CHWs were more likely to be motivated by altruism, intrinsic needs and skill utilization, community respect and hope for employment. Less educated CHWs were more satisfied with service and quality factors and more wealthy CHWs satisfied with job aids.Conclusion and recommendationsA combination of financial and non-financial incentives is required to support motivation and satisfaction among CHWs. Although CHWs joined mainly due to their altruistic nature, they became discontented with the lack of monetary compensation, transportation and communication support received. With the planned rollout of the national CHW cadre, improved understanding of CHWs as a heterogeneous group with nuanced needs and varied ambitions is vital for ensuring sustainability.

Highlights

In 2012, the Ministry of Health and Social Welfare (MOHSW), Tanzania, approved national guidelines and training materials for community health workers (CHWs) in integrated maternal, newborn and child health (Integrated MNCH), with CHWs trained and deployed across five districts of Morogoro Region soon after
In countries where effective CHW programmes are in existence, studies show that CHWs are successful in improving health service coverage, continuity of care and health outcomes [3,4,5,6,7]
MNCH CHW characteristics A total of 228 of 238 (96 %) CHWs trained by the Integrated MNCH Programme prior to the study were interviewed with a median age of 32 (Table 1)

Summary

Introduction

In 2012, the Ministry of Health and Social Welfare (MOHSW), Tanzania, approved national guidelines and training materials for community health workers (CHWs) in integrated maternal, newborn and child health (Integrated MNCH), with CHWs trained and deployed across five districts of Morogoro Region soon after. Like many other low-income countries, is experiencing chronic shortages of facility-based healthcare providers It has four health professionals, including physicians, nurses and midwives, for every 10 000 people [1], in contrast to the 25 health professionals per 10 000 people recommended by WHO for achieving adequate coverage of critical maternal, newborn and child health (MNCH) interventions [2]. This acute shortage of health workers in Tanzania is stalling improvements in MNCH outcomes and threatening the country’s potential for achieving the Millennium Development Goals (MDGs). In countries where effective CHW programmes are in existence, studies show that CHWs are successful in improving health service coverage, continuity of care and health outcomes [3,4,5,6,7]

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