The relative importance of material and non-material incentives for community health workers: Evidence from a discrete choice experiment in Western Kenya.

Motivating community health workers (CHWs), many of whom are volunteers, is important for the sustainability of integrated community case management programs. Given the limited budgets of many of these programs, and the increasingly important role played by CHWs, it is crucial to not only identify important motivators driving their engagement, but also which incentives could have the greatest impact on CHW motivation in their role. In this study, we aimed to assess CHWs' relative preferences for material and non-material incentives. We conducted a discrete choice experiment (DCE) with 199 randomly selected CHWs, working in 32 communities in western Kenya, to measure the relative importance that CHWs place on different incentives. Each CHW completed a series of 10 choice tasks (8 random, 2 fixed), where they had to choose between two hypothetical positions that had varying levels of monthly mobile phone airtime, training, monthly transport bonus, community appreciation and health facility staff appreciation of their work. Data was analyzed using mixed logit models. CHWs' most preferred job characteristic was high levels of community appreciation for their work which was valued approximately equivalently to receiving a 2000 Kenya Shillings (~US $20) monthly transport allowance. These incentives were valued more than appreciation from health facility staff or trainings six times per year. This study demonstrates that investing in efforts to improve community members' knowledge and recognition of CHWs' contribution to community health may have a significant impact on CHWs' motivation and retention in their role.

Motivation and satisfaction among community health workers administering rapid diagnostic tests for malaria in Western Kenya.

BACKGROUND: The continued success of community case management (CCM) programs in low-resource settings depends on the ability of these programs to retain the community health workers (CHWs), many of whom are volunteers, and maintain their high-quality performance. This study aims to identify factors related to the motivation and satisfaction of CHWs working in a malaria CCM program in two sub-counties in Western Kenya. METHODS: We interviewed 70 CHWs who were trained to administer malaria rapid diagnostic tests as part of a broader study evaluating a malaria CCM program. We identified factors related to CHWs' motivation and their satisfaction with participation in the program, as well as the feasibility of program scale-up. We used principal components analysis to develop an overall CHW satisfaction score and assessed associations between this score and individual CHW characteristics as well as their experiences in the program. RESULTS: The majority of CHWs reported that they were motivated to perform their role in this malaria CCM program by a personal desire to help their community (69%). The most common challenge CHWs reported was a lack of community understanding about malaria diagnostic testing and CHWs' role in the program (39%). Most CHWs (89%) reported that their involvement in the diagnostic testing intervention had either a neutral or a net positive effect on their other CHW activities, including improving skills applicable to other tasks. CHWs who said they strongly agreed with the statement that their work with the malaria program was appreciated by the community had a 0.76 standard deviation (SD) increase in their overall satisfaction score (95% confidence interval CI = 0.10-1.24, P = 0.03). Almost all CHWs (99%) strongly agreed that they wanted to continue their role in the malaria program. CONCLUSIONS: Overall, CHWs reported high satisfaction with their role in community-based malaria diagnosis, though they faced challenges primarily related to community understanding and appreciation of the services they provided. CHWs' perceptions that the malaria program generally did not interfere with their other activities is encouraging for the sustainability and scale-up of similar CHW programs.