‘CHWs value feedback and feeling connected to the health system and their community, are motivated by status and community standing, and want to be provided with the necessary tools to perform.’ The authors of this new paper in Human Resources for Health journal describe six key guiding principles:

1. CHWs are motivated by their status and standing in the community and a sense of the value they add

2. CHWs value technical feedback and supportive encouragement from both supervisors and community members

3. Feeling connected to both the health system and the community they serve motivates and validates CHWs in their role

4. Adequate resources—especially drugs—must be in place for CHWs to be motivated and perform

5. Participatory activities in the community that are open to all, enjoyable, purposeful and focused on positive local health outcomes delivered through the CHWs are likely to sustain community interest and engagement and be motivating for CHWs (in Uganda)

6. Interventions supported by ICT that facilitate easy communication, provide contextspecific technical support and engender a sense of connectedness to the health system, supervisors and peers are feasible and acceptable to CHWs in Uganda and Mozambique and likely to increase CHW motivation

Below are the citation and abstract. The full text is freeely available here: http://www.human-resources-health.com/content/pdf/s12960-015-0020-8.pdf  

CITATION: Using theory and formative research to design interventions to improve community health worker motivation, retention and performance in Mozambique and Uganda.

Daniel Llywelyn Strachan, Karin Källander, Maureen Nakirunda, Sozinho Ndima, Abel Muiambo, Zelee Hill and the inSCALE study group

Corresponding author: Daniel L Strachan d.strachan@ucl.ac.uk

Human Resources for Health 2015, 13:25  doi:10.1186/s12960-015-0020-8

Published: 30 April 2015

ABSTRACT (provisional)

Background: Community health workers (CHWs) are increasingly being used in low-income countries to address human resources shortages, yet there remain few effective, evidence-based strategies for addressing the enduring programmatic constraints of worker motivation, retention and performance. This paper describes how two interventions were designed by the Innovations at Scale for Community Access and Lasting Effects (inSCALE) project to address these constraints in Uganda and Mozambique drawing on behavioural theory and formative research results.

Methods: A review of the work motivation and CHW motivation literature—incorporating influences on retention and performance—was conducted on articles sourced through electronic web searches. Formative research with a focus on the barriers and facilitators to CHW motivation, retention and performance was conducted with community health workers and key stakeholders in Uganda and Mozambique. An analytical induction approach to the thematic analysis of transcripts from 98 in-depth interviews and 26 focus group discussions was adopted across the country settings.

Results: From the theoretical review, it was determined that the interventions should promote CHWs as members of a collective by highlighting a sense of shared experience, focus on alignment between worker and programme goals, and emphasise the actions that lead to good performance. The Social Identity Approach was selected as the theory most likely to lead to the development of effective, scalable and sustainable interventions by addressing the identified gap in the literature of the influence of CHW working context. The formative research indicated that CHWs value feedback and feeling connected to the health system and their community, are motivated by status and community standing, and want to be provided with the necessary tools to perform. Two interventions based on these results were developed: a participatory, local community approach and an information communication technology (ICT) approach.

Conclusions: Drawing on contextual data and theory that is sensitive to context can potentially lead to the development of appropriate and effective interventions when aiming to improve the motivation, retention and performance of CHWs in Uganda and Mozambique and other comparable settings. Evaluation of the developed interventions is crucial to assess this potential.

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Best wishes, Neil

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