Qualitative assessment of community health workers\u2019 perspective on their motivation in community-based primary health care in rural Malawi

Myness Kasanda Ndambo,Emilia Connolly,Basimenye Nhlema,Fabien Munyaneza,Moses Banda Aron

doi:10.1186/s12913-022-07558-6

Abstract

BackgroundCommunity Health Workers (CHWs) have a positive impact on the provision of community-based primary health care through screening, treatment, referral, psychosocial support, and accompaniment. With a broad scope of work, CHW programs must balance the breadth and depth of tasks to maintain CHW motivation for high-quality care delivery. Few studies have described the CHW perspective on intrinsic and extrinsic motivation to enhance their programmatic activities.MethodsWe utilized an exploratory qualitative study design with CHWs employed in the household model in Neno District, Malawi, to explore their perspectives on intrinsic and extrinsic motivators and dissatisfiers in their work. Data was collected in 8 focus group discussions with 90 CHWs in October 2018 and March–April 2019 in seven purposively selected catchment areas. All interviews were audiotaped, transcribed verbatim, coded, and analyzed using Dedoose.ResultsThemes of complex intrinsic and extrinsic factors were generated from the perspectives of the CHWs in the focus group discussions. Study results indicate that enabling factors are primarily intrinsic factors such as positive patient outcomes, community respect, and recognition by the formal health care system but can lead to the challenge of increased scope and workload. Extrinsic factors can provide challenges, including an increased scope and workload from original expectations, lack of resources to utilize in their work, and rugged geography. However, a positive work environment through supportive relationships between CHWs and supervisors enables the CHWs.ConclusionThis study demonstrated enabling factors and challenges for CHW performance from their perspective within the dual-factor theory. We can mitigate challenges through focused efforts to limit geographical distance, manage workload, and strengthen CHW support to reinforce their recognition and trust. Such programmatic emphasis can focus on enhancing motivational factors found in this study to improve the CHWs’ experience in their role. The engagement of CHWs, the communities, and the formal health care system is critical to improving the care provided to the patients and communities, along with building supportive systems to recognize the work done by CHWs for the primary health care systems.

Highlights

Community Health Workers (CHWs) have a positive impact on the provision of community-based primary health care through screening, treatment, referral, psychosocial support, and accompaniment
CHWs’ motivation and performance were influenced by diverse elements that arise from the complex context in which they work as a conduit between the community and the formal health care system
A New = < 5 years working; Old = > 5 years working for CHWs except for geographical accessibility, which was a consistent barrier in this environment (Fig. 1)

Summary

Introduction

Community Health Workers (CHWs) have a positive impact on the provision of community-based primary health care through screening, treatment, referral, psychosocial support, and accompaniment. CHWs are a vital, diverse group that links people from their homes and communities to critical health and social services within their communities [6] Their responsibilities may include screening, providing education, promoting access to and linkage to PHC services, engaging in highly specific disease-related activities such as medication observation and adherence, and even direct patient care [4, 7, 8]. Previous studies suggest that CHWs are motivated by trust and respect from patients and the community, managers’ support and encouragement, and health knowledge acquisition that can be shared in their communities They are dissatisfied by poor incentives and working conditions, limited health supplies and equipment, disrespect and limited support from the formal health care workers, and lack of transportation [15,16,17,18]. These motivation factors are broadly reported, but the contextualization is less commonly described, especially in a rural householdbased CHW programs to inform program implementation and improvement

Methods

Results

Discussion

Conclusion