Getting more than "claps": incentive preferences of voluntary community-based mobilizers in Tanzania.

BACKGROUND: Marie Stopes Tanzania works with a voluntary cadre of 66 community-based mobilizers (CBMs), who are tasked with raising awareness, generating demand and providing referral to potential clients for family planning, comprehensive post-abortion care and cervical cancer screening. CBMs extend the reach of urban clinics to peri-urban communities, enhancing access to sexual and reproductive health services. In an effort to optimize performance of CBMs, a study was conducted to explore the drivers of CBM motivation and inform the design of an incentive scheme. METHODS: Three focus group discussions with 17 CBMs and 11 interviews with CBM supervisors and managers were conducted in three clinics and the head office. After thematic analysis of transcripts, findings on motivational factors were discussed in a reflection workshop and informed the development of a discrete choice experiment (DCE) involving 61 CBMs as respondents. The DCE included eight choice questions on two incentive schemes, each consisting of five attributes related to remuneration, training, supervision, benefits and identification. For each attribute, different incentive options were presented, based on the outcomes of the qualitative assessment. The DCE results were analysed using conditional logistic regression. RESULTS: A variety of factors motivated CBMs. Most CBMs were motivated to conduct their work because of an intrinsic desire to serve their community. The most mentioned extrinsic motivational factors were recognition from the community and supervisors, monthly allowance, availability of supporting materials and identification, trainings, supervision and feedback on performance. Recommendations for improvement were translated into the DCE. Incentive attributes that were found to be significant in DCE analysis (p < 0.05), in preference order, were carrying an ID card, bi-monthly training, supervision conducted via both monthly meetings at clinics and visits from the head office, and a monthly flat rate remuneration (over pay for performance). CONCLUSION: Despite the recognition that being a CBM is voluntary, incentives, especially those of non-financial nature, are important motivators. Incentive schemes should include basic compensation with a mix of other incentives to facilitate CBMs' work and enhance their motivation. Programme designs need to take into account the voices of community-based workers, to optimize their performance and service delivery to communities they serve.

Economic assessment of US physician participation in short-term medical missions.

BACKGROUND: Short term medical missions (STMMs) are a form of unregulated and unsanctioned, grass roots, direct medical service aid from wealthier countries to low and middle income countries. The US leads the world in STMM activity. The magnitude of monetary and man power inputs towards STMMs is not clear. The objective of this study is to estimate the prevalence of physician participation in STMMs from the US and the related expenditures of cash and resources. METHODS: An online survey solicited information on physician participation in STMMs. Responses regarding costs were aggregated to estimate individual and global expenditures. RESULTS: Sample statistics from 601 respondent physicians indicate an increasing participation by US physicians in STMMs. Including opportunity cost, average total economic inputs for an individual physician pursuing an STMM exceed $11,000. Composite expenditures for STMM deployment from the US are estimated at near $3.7 billion annually and the resource investment equates with nearly 5800 physician fulltime equivalents. CONCLUSIONS: STMM participation and mission numbers have been increasing in the millennium. The aggregate costs are material when benchmarked against formal US aid transfers. Understanding the drivers of physician volunteerism in this activity is thereby worthy of study and relevant to future policy deliberation.

Time volunteered on community health activities by brigadistas in Nicaragua.

OBJECTIVE: To report on how brigadistas ("health brigadiers") in Nicaragua volunteer their time before the introduction of expanded responsibilities (beyond the scope of integrated community case management (iCCM)) for sick children 2-59 months old. METHODS: Three complete teams of brigadistas (n = 12 brigadistas total) were selected from remote communities in the department of Matagalpa. Each respondent brigadista was interviewed privately regarding the frequency and duration (i.e., preparation, round-trip travel, and implementation time) of 13 separate activities. The correlation between their overall estimates and summed times of individual activities were measured. RESULTS: Brigadista mean density was 1 per 156 total population (range: 120-217). Each team had one encargado/a ("manager") with an iCCM drug box plus two to four asistentes ("assistants"). All resided in the community they served. Eight reported competing time demands during one to nine months of the year. Brigadistas volunteered an average of 75 hours per month (range: 35-131). Encargados were busier than asistentes (98 versus 68 hours per month). Three activities accounted for 70% of their time: 1) iCCM (30%: treatment (11%), follow-up (19%)); 2) receiving training (21%); and 3) promoting birth planning (19%). Brigadistas' time was divided among preparation (12%), travel (27%), and implementation (61%). Overall estimates were highly correlated (+0.70) with summed implementation time. CONCLUSIONS: Brigadistas from these remote Nicaraguan communities were busy with different activities, levels of effort, and patterns of task-sharing. These findings, plus an ongoing job satisfaction survey and a follow-on time study after the introduction of the new interventions, will inform policy for this valuable volunteer cadre.

"Contract to Volunteer": South African Community Health Worker Mobilization for Better Labor Protection.

In this paper, we explore the increasing activity around labor rights for South African community health workers (CHWs). Contextualizing this activity within broader policy and legal developments, we track the emergence of sporadic mobilizations for decent work (supported by local health activist organizations) and subsequently, the formation of a CHW union. The National Union of Care Workers of South Africa (NUCWOSA) was inaugurated in 2016, hoping to secure formal and secure employment through government and the consequent labor and occupational health protections. Various tensions were observed during fieldwork in the run up to NUCWOSA's formation and raise important questions about representation, legitimacy, and hierarchies of power. We close by offering suggestions for future research in this developing space.

[The voluntary health auxiliary. Application to the Peruvian Altiplano of new concepts of primary health care in disadvantaged communities]. / L'auxiliaire volontaire de santé. Application à l' Altiplano péruvien des nouveaux concepts concernant les soins de santé primaires des collectivités défavorisées.

A group a Swiss physicians, who have been working for about eight years in rural health posts of the Peruvian highlands (Altiplano), engaged in training voluntary health auxiliaries, chosen by the indigenous communities. Experience has shown that, as in other countries, it is thus possible to markedly improve the health of populations which badly lack resources. The efficacy of using such auxiliaries was recognized by the Peruvian Ministry of Health, which has now set up a programme for their training and supervision. Within the concept of primary health care, based on the participation of people to the management of their health, the voluntary health auxiliary is placed in a strategic and decisive position for the success of an enterprise which is now spreading to many countries of the Third World.

Volunteer faculty: what rewards or incentives do they prefer?

BACKGROUND: Clerkship directors and college administrators have concerns about recruitment and retention of practicing physicians for volunteer teaching. There is a paucity of data regarding the rewards and incentives offered to, or desired by, the nonsalaried community-based practicing physicians who volunteer their time to teach. PURPOSE: This study was designed to gain information about rewards and incentives from volunteer teachers in pediatric, family practice, and internal medicine clerkships. METHODS: We surveyed nonsalaried physician teachers of internal medicine, family medicine, and pediatrics across the United States. The survey focused on teachers' evaluation of the rewards or incentives offered by the programs in the following categories: educational opportunities, services or gifts, recognition bestowed by the school, academic appointments, and monetary payments. Respondents rated each item from 1 (not appreciated) to 5 (very much appreciated). They also were asked to rank order the rewards or incentives (with the addition of a category of personal satisfaction) from 1 (least appreciated) to 6 (most appreciated). RESULTS: Educational opportunities received high ratings, especially when the school bore the cost of providing a service. Payment for teaching was offered to 37% of the respondents, and those who were paid rated it higher. Overall, payment for teaching had a mean appreciation score of 3.94, second only to travel and meeting registration reimbursement (4.27). However, in the rank order listing, personal satisfaction had the highest rank (5.16). In contrast, payment for teaching (2.92) and gifts or services from the college (2.53) were at the bottom of the rank order. CONCLUSION: The survey asked practicing physicians the value they placed on awards and incentives provided to them by the college. This information should help administrators and clerkship directors in recruiting and retaining community-based practicing physicians for teaching.