Motivations and challenges of community-based surveillance volunteers in the northern region of Ghana.

Community health workers (CHWs) are an important element of many health systems and programmes for the promotion and delivery of a wide range of health interventions and disease surveillance. Understanding the motivation and retention of CHWs is recognized as essential but there are few data from sub-Saharan Africa. This qualitative study explored factors that motivate, and the challenges faced by community-based surveillance volunteers (CBSVs) in the Northern Region of Ghana through semi-structured interviews with 28 CBSVs, 12 zonal coordinators, nine Ghana Health Service (GHS) sub-district level staff, ten GHS district level staff and two GHS regional level staff in the administrative capital. The community emerged as an important motivating factor in terms of altruism, a sense of duty to the community and gaining community respect and pride. This was enhanced by community selection of the volunteers. Major challenges included incorrect community perceptions of CBSVs, problems with transportation and equipment, difficulties conducting both volunteer and farm work and late or lack of payment for ad hoc tasks such as National Immunization Days. Most CBSVs recognized that they were volunteers, understood the constraints of the health system and were not demanding remuneration. However, CBSVs strongly desired something tangible to show that their work is recognized and appreciated and described a number of low cost items that could be used. They also desired equipment such as raincoats and identifiers such as tee-shirts and certificates.

Why is dracunculiasis eradication taking so long?

The long time needed for global eradication of dracunculiasis (Guinea worm disease) was not anticipated at the outset. The successful eradication of smallpox in 10 years compares with the target date set in 1985 for dracunculiasis eradication - 1995. Seventeen years after that date, transmission continues. Why? Various factors are responsible, mainly lack of resources, or resources ineffectively used. The example of Ghana, where the programme stagnated for a decade, sheds light on this delay. When more resources were put into Ghana's programme in 2007, transmission of the disease was interrupted in 3 years. The variable success of dracunculiasis eradication in different countries provides lessons for future disease eradication programmes.