Motivation and job satisfaction of community health workers in Ethiopia: a mixed-methods approach

Financial motivation models for community health workers in low- and middle-income countries: a scoping review

Community health workers (CHWs) are key players in providing primary healthcare in low- and middle-income countries. However, their absence from the formal health system in many of these countries often presents a challenge to their remuneration. The objective of this scoping review is to document programs implemented at both small and large scales in low- and middle-income countries, the remuneration strategies they have established, and the effects of these strategies on the work of CHWs. In total, we included 50 articles in this review. We have identified four types of compensation: fixed compensation, performance-based compensation, compensation based on income-generating activities (IGAs), and combined compensation. We identified the strengths and weaknesses of each type of compensation. A common strength for most models was improvement in motivation and performance. A common weakness for most models was irregular payments. The results of this review highlight the need to consider the economic, social, and cultural settings of the countries or environments at hand, and to include CHWs in discussions regarding the selection of a compensation model.

Building systems' resilience in the mpox outbreak response in Africa

No abstract available.

Barriers and Facilitators to the Implementation of Government Policies on Infant and Young Child Feeding and Food Fortification in Benin

BackgroundTo prevent micronutrient deficiencies and address the double burden of malnutrition, Benin has implemented Infant and Young Child Feeding (IYCF) and food fortification policies for several years. Despite these efforts, significant micronutrient deficiencies persist, posing a public health problem.ObjectiveThis study aims to identify barriers and facilitators to the implementation of government policies on IYCF and food fortification in Benin.MethodsWe conducted in-depth individual interviews with 23 key national and local stakeholders involved in implementing these policies. The interviews were recorded, transcribed, and analyzed through a deductive and iterative process based on the study's objective.ResultsStakeholders identified several barriers to policy implementation, including low staff motivation, exacerbated by poor personnel management and lack of recognition. Financial resources are insufficient despite organizational support. Training and awareness among health workers and producers are limited outside UNICEF's intervention areas. Traditional eating habits and cultural resistance impede the adoption of new practices. The monitoring system is complex and ill-equipped, hindering quality control of fortified foods. Facilitators include strong political commitment, partnerships with international nongovernmental organizations, and effective intersectoral collaboration. These partnerships have improved training and community awareness, though gaps remain. The involvement of local producers and professional associations also supports food fortification initiatives.ConclusionNutrition policies in Benin face challenges such as low staff motivation and lack of resources. However, strong political commitment and international partnerships present opportunities to overcome these barriers.Plain language titleStudy of Challenges and Solutions to Improve Food Policies for Babies and Children in Benin.

Capacity-building interventions for health extension workers in Ethiopia: A scoping review

INTRODUCTION

Capacity-building interventions for health extension workers (HEWs) are key to providing quality health services to the community. Since Ethiopia's Health Extension Program was established, several types of capacity-building interventions have been developed to build HEW competencies. However, no comprehensive study has mapped the types of capacity-building interventions being used or the competencies targeted.

OBJECTIVE

To (1) identify and characterize evidence on capacity-building interventions for Ethiopian HEWs, including the competencies measured; (2) clarify evidence gaps in this area; and (3) explore how successful the interventions have been to inform the design of health extension programs and further research.

METHODS

We used keywords (health extension workers, capacity building, competencies) and related terminologies to search PubMed, Scopus, and Embase for published studies on capacity-building interventions for Ethiopian HEWs, and Google Scholar for unpublished studies and reports. Our search was limited to studies and reports published in English from 2003 to present. We used the JBI scoping review methodology to conduct this scoping review in a stepwise approach and a categorization approach to synthesize the evidence.

RESULTS

Our search strategy identified 20 articles, all published except for one program report. The most common capacity-building intervention designed for HEWs was training, followed by supportive supervision, performance review and clinical mentoring meetings, and equipment supply; the most salient competency domains investigated were knowledge and skills. The interventions significantly improved immediate outcomes (knowledge, skills, attitude change among HEWs) and intermediate outcomes, such as increased service utilization and health-seeking behavior among community members. Only one study assessed whether capacity-building interventions improved inter- and intra-personal domains of capacity/competency.

CONCLUSIONS

Capacity-building interventions for Ethiopian HEWs were found to be effective, but they mainly focused on improving technical competencies, such as knowledge and skills. Little attention has been paid to other competency domains, including motivation, leadership, and communication. Thus, future research could focus on a comprehensive set of capacity-building initiatives that addresses motivation, job satisfaction, communication, commitment, and resource allocation.

Scope of work and contributions of female community health volunteers in Nepal's healthcare sector: a qualitative study

OBJECTIVES

To determine the perception of female community health volunteers (FCHVs) in terms of their scope of work, impact of work on their professional experiences and their coping strategies and stakeholders' perception of FCHVs programme, their contribution to the health sector and its sustainability.

DESIGN

A qualitative study involving in-depth interviews (IDIs) with FCHVs and key informant interviews (KIIs) with local stakeholders. All the interviews were conducted through telephone.

SETTING

Six municipalities in Kavre district, Nepal.

PARTICIPANTS

16 FCHVs participated in IDIs and 12 local stakeholders involving members of mother's group, health workers and local ward representatives of the selected municipalities were involved in KIIs from May to August 2021.

RESULTS

The FCHVs perceived a sense of workload because of their wide scope of work. The major challenges faced by FCHVs were limited allowances and incentives for their contribution, negative and judgemental attitudes, geographical challenges, multitasking, inadequate supply of health commodities and limited infrastructures for service delivery. Both the FCHVs and the stakeholders perceived the FCHV programme as one of the most effective programmes supporting the health system. However, they seem concerned about the sustainability of FCHVs programme. In addition, they indicated that the FCHVs could possibly alleviate the shortage of health workforce by providing preventive and promotive healthcare services at the grassroot level.

CONCLUSION

Our study showed a need for systematic and integrated health programme delivery packages thereby reducing additional workload and burden among FCHVs.

Primary Health Care Systems and Their Contribution to Universal Health Coverage and Improved Health Status in Seven Countries: An Explanatory Mixed-Methods Review

BACKGROUND

Primary health care (PHC) systems and their successes and challenges vary between and within countries. We elucidate the role of PHC on health status and universal health coverage (UHC) by describing the achievements and challenges of PHC systems in seven countries representing the three economic levels: high-income (Belgium, Australia), middle-income (South Africa, Thailand), and low-income countries (Cambodia, Ethiopia, and Nepal).

METHODS

We adopted a mixed-methods approach and (a) extracted quantitative data on the key health and universal health coverage index of countries and (b) conducted a scoping review of the PHC systems in these countries. We used key terms related to the following eight domains: service delivery, health workforce, health information system, health financing, medicines, and leadership and governance (the WHO's building blocks for national health systems) and community participation and multisectoral actions (other pillars of PHC) to identify the relevant literature and searched six databases: PubMed, Scopus, Embase, PsycINFO, CINAHL, and Cochrane Library. A total of 58 articles were identified and included in this review; data were charted and synthesised narratively.

RESULTS

There is variation in health services coverage and health status across the three economic levels. Countries expanded access to PHC services using strategies like telehealth and CHWs but faced challenges in sustainability, workforce retention, and service quality. Community engagement and multisectoral actions helped, though gaps in governance, resources, and essential medicines hindered progress towards UHC.

CONCLUSIONS

By addressing the challenges and leveraging successful strategies, countries can move closer to achieving the goal of universal health coverage and improving health outcomes for all.

Job satisfaction and associated factors among rural health extension workers in Buno Bedele Zone South West Ethiopia

Job satisfactions have impacts on productivity and essentials provision of care for maternal and child health in the rural area. Despite Health extension workers (HEWs) have pivotal role towards improvement of maternal and child health outcome, there is scarcity of data regarding their job satisfaction, hence this study was employed to assess the level of job satisfaction and associated factors among rural HEW in Buno Bedele Zone, Southwest Ethiopia. A Facility based cross-sectional study design was conducted among 393 randomly selected HEW from May to June, 2023. A pretested; questionnaire was used to collect the data. SPSS version 25 was used for statistical analysis. Logistic regression analysis with odds ratio (OR), a 95% CI and P < 0.05 were used to declare statistical significance. The overall satisfaction of health extension workers was 45.5%, [95% Confidence interval CI 44.0-46.09]. Availability of residence [AOR = 2.349, 95% CI 1.352, 4.083], transfer between kebeles [AOR = 0.267, 95% CI 0.132, 0.540], availability of medical supply [AOR = 2.853, 95% CI 1.474, 5.523], Good working environment [AOR = 3.395, 95% CI 2.017, 5.717], Getting technical support during work from their supervisor [AOR = 3.656, 95% CI 1.851, 7.219] were significantly associated factors with HEW job satisfaction. More than half of the health extension workers were dissatisfied with their jobs. Availability of living home, Transfer, medical supply, Environment, Support was predictor of job satisfaction. It is crucial to encourage intervention mode that may enhance their satisfaction and motivation of HEWs to improve service provision.

Exploring the motivations of female community health volunteers in primary healthcare provision in rural Nepal: A qualitative study

Motivating Community Health Workers (CHWs)-many of whom are volunteers-is crucial for achieving Universal Healthcare Coverage (UHC) for Primary Healthcare (PHC) in resource-poor areas. In rural Nepal, PHC is mostly delivered by female CHWs, locally known as Female Community Health Volunteers (FCHVs), but little is known about them. This paper explores experiential factors influencing FCHVs' motivations, including how motivation intersects with women's livelihoods and consider what this means for achieving PHC in Nepal and globally. We conducted qualitative research in the hill and the Terai (flatland bordering India) areas of Nepal. Data were purposively collected through 31 semi-structured interviews (20 volunteers, 11 paid local health workers) and three focus group discussions with additional 15 volunteers. All interviews were audio-recorded, transcribed verbatim in Nepali and translated into English. Data were coded using NVivo10, analysed thematically at individual, organisational and community levels. FCHVs' motivations to volunteer was affected in several ways. At the individual level, participants wanted and were committed to voluntary work, yet the opportunity costs of volunteering, out-of-pocket expenditure and inadequate family support strained many of the women who were already overburdened. At the community level, perceived lack of appreciation of volunteer efforts by community members, who saw volunteers as paid health workers, undermined FCHVs motivation to volunteer. Finally, at the organizational level, a bureaucratic emphasis on recording and reporting, and lack of respect from local health workers undermined their motivation at work. Our paper illustrates how FCHVs from some of the poorest backgrounds can be highly motivated to volunteer, yet inadequate social and economic support across individual, organisational and community levels undermined this motivation, the security of their livelihoods, and thus wider efforts to achieve PHC. Financial investments are needed to compensate FCHVs, so that they remain motivated to deliver global health goals for PHC.

The use and potential impact of digital health tools at the community level: results from a multi-country survey of community health workers

BACKGROUND

Community health workers (CHWs) are increasingly viewed as a critical workforce to address health system strengthening and sustainable development goals. Optimizing and widening the capacity of this workforce through digital technology is currently underway, though there is skepticism regarding CHWs' willingness and optimism to engage in digital health. We sought to understand CHWs' perceptions on the use of digital health tools in their work.

METHODS

We obtained survey data from 1,141 CHWs from 28 countries with complete study information. We conducted regression analyses to explore the relationship between CHWs' training and perceived barriers to digital health access with current use of digital devices/tools and belief in digital impact while adjusting for demographic factors.

RESULTS

Most of the CHWs worked in Kenya (n = 502, 44%) followed by the Philippines (n = 308, 27%), Ghana (n = 107, 9.4%), and the United States (n = 70, 6.1%). There were significant, positive associations between digital tools training and digital device/tool use (Adjusted Odds Ratio (AOR) = 2.92, 95% CI = 2.09-4.13) and belief in digital impact (AORhigh impact = 3.03, 95% CI = 2.04-4.49). CHWs were significantly less likely to use digital devices for their work if they identified cost as a perceived barrier (AORmobile service cost = 0.68, 95% CI = 0.49-0.95; AORphone/device cost = 0.66, 95% CI = 0.47-0.92). CHWs who were optimistic about digital health, were early adopters of technology in their personal lives, and found great value in their work believed digital health helped them to have greater impact. Older age and greater tenure were associated with digital device/tool use and belief in digital impact, respectively.

CONCLUSIONS

CHWs are not an obstacle to digital health adoption or use. CHWs believe that digital tools can help them have more impact in their communities regardless of perceived barriers. However, cost is a barrier to digital device/tool use; potential solutions to cost constraints of technological access will benefit from further exploration of reimbursement models. Digital health tools have the potential to increase CHW capacity and shape the future of community health work.

Work motivation and factors associated with it among health professionals in Debre Markos Comprehensive Specialized Hospital

Motivation is the level of a person's willingness to put forth and maintain an effort in support of organizational goals. However, motivation towards task execution is affected by the organization and individual goals. For instance, low morale among the staff can damage the quality of service delivery. Hence, this study was intended to assess the working motivation status and factors associated with it among health professionals at Debre Markos Comprehensive Specialized Hospital. A hospital-based cross-sectional study was employed. Stratified sampling techniques were used to extract sample from each job category proportionally. To make the distribution fair, all health workers were grouped according to their job title and selected by using the lottery method from each group. A standardized, self-administered questionnaire was used to collect data. Data was checked, coded, and entered into EpiData 3.1 and exported for analysis into SPSS 25. Variable in the multivariable logistic regression model with a p value of < 0.05 at 95% CI were taken as significantly associated to motivation status. A total of 319 people were involved, with a 100% response rate. 20.4% of health professionals were motivated at Debre Markos Comprehensive Specialized Hospital. Job satisfaction (AOR 6.46, 95% CI 1.72, 24.35), the presence of adequate medical supplies (AOR 5.01, 95% CI 1.23, 25.37), work place security (AOR 6.78, 95% CI 1.498, 30.72), and the presence of training opportunities in health facilities (AOR 2.23, 95% CI 1.01, 4.96) were significant factors associated with motivation status. The proportion of motivated health professionals was very low compared to previous studies in Ethiopia. The presence of security at work, adequate medical equipment, drugs, and supplies, job satisfaction, and the presence of training opportunities were predominant motivational factors. The hospital administration needs to give priority and work to safeguard security, ensure adequate medical supplies, and offer training to improve their satisfaction and motivation.