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Salaried and voluntary community health workers: exploring how incentives and expectation gaps influence motivation.
Ormel, Hermen; Kok, Maryse; Kane, Sumit; Ahmed, Rukhsana; Chikaphupha, Kingsley; Rashid, Sabina Faiz; Gemechu, Daniel; Otiso, Lilian; Sidat, Mohsin; Theobald, Sally; Taegtmeyer, Miriam; de Koning, Korrie.
Afiliación
  • Ormel H; Royal Tropical Institute, KIT Health, P.O. Box 95001, 1090 HA, Amsterdam, The Netherlands. h.ormel@kit.nl.
  • Kok M; Royal Tropical Institute, KIT Health, P.O. Box 95001, 1090 HA, Amsterdam, The Netherlands.
  • Kane S; Royal Tropical Institute, KIT Health, P.O. Box 95001, 1090 HA, Amsterdam, The Netherlands.
  • Ahmed R; Eijkman Institute for Molecular Biology, Jalan Diponegoro 69, Jakarta, 10430, Indonesia.
  • Chikaphupha K; Research for Equity and Community Health (REACH) Trust, P.O. Box 1597, Lilongwe, Malawi.
  • Rashid SF; BRAC James P. Grant School of Public Health, BRAC University, Mohakhali, Dhaka, Bangladesh.
  • Gemechu D; HHA-YAM, P.O. Box 303, Hawassa, Ethiopia.
  • Otiso L; LVCT Health, Research and Strategic Information Department, P.O. Box 19835-00202, Nairobi, Kenya.
  • Sidat M; Department of Community Health, University Eduardo Mondlane, P.O. Box 257, Maputo, Mozambique.
  • Theobald S; Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
  • Taegtmeyer M; Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
  • de Koning K; Royal Tropical Institute, KIT Health, P.O. Box 95001, 1090 HA, Amsterdam, The Netherlands.
Hum Resour Health ; 17(1): 59, 2019 07 19.
Article en En | MEDLINE | ID: mdl-31324192
BACKGROUND: The recent publication of the WHO guideline on support to optimise community health worker (CHW) programmes illustrates the renewed attention for the need to strengthen the performance of CHWs. Performance partly depends on motivation, which in turn is influenced by incentives. This paper aims to critically analyse the use of incentives and their link with improving CHW motivation. METHODS: We undertook a comparative analysis on the linkages between incentives and motivation based on existing datasets of qualitative studies in six countries. These studies had used a conceptual framework on factors influencing CHW performance, where motivational factors were defined as financial, material, non-material and intrinsic and had undertaken semi-structured interviews and focus group discussions with CHWs, supervisors, health managers and selected community members. RESULTS: We found that (a mix of) incentives influence motivation in a similar and sometimes different way across contexts. The mode of CHW engagement (employed vs. volunteering) influenced how various forms of incentives affect each other as well as motivation. Motivation was negatively influenced by incentive-related "expectation gaps", including lower than expected financial incentives, later than expected payments, fewer than expected material incentives and job enablers, and unequally distributed incentives across groups of CHWs. Furthermore, we found that incentives could cause friction for the interface role of CHWs between communities and the health sector. CONCLUSIONS: Whether CHWs are employed or engaged as volunteers has implications for the way incentives influence motivation. Intrinsic motivational factors are important to and experienced by both types of CHWs, yet for many salaried CHWs, they do not compensate for the demotivation derived from the perceived low level of financial reward. Overall, introducing and/or sustaining a form of financial incentive seems key towards strengthening CHW motivation. Adequate expectation management regarding financial and material incentives is essential to prevent frustration about expectation gaps or "broken promises", which negatively affect motivation. Consistently receiving the type and amount of incentives promised appears as important to sustain motivation as raising the absolute level of incentives.
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Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Voluntarios / Actitud del Personal de Salud / Agentes Comunitarios de Salud / Motivación Tipo de estudio: Qualitative_research Límite: Adult / Female / Humans / Male País/Región como asunto: Africa Idioma: En Revista: Hum Resour Health Año: 2019 Tipo del documento: Article País de afiliación: Países Bajos

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Voluntarios / Actitud del Personal de Salud / Agentes Comunitarios de Salud / Motivación Tipo de estudio: Qualitative_research Límite: Adult / Female / Humans / Male País/Región como asunto: Africa Idioma: En Revista: Hum Resour Health Año: 2019 Tipo del documento: Article País de afiliación: Países Bajos