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Salaried and voluntary community health workers: exploring how incentives and expectation gaps influence motivation

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Ormel, Hermen, Kok, Maryse, Kane, Sumit, Chikaphupha, Kingsley, Ahmed, Rukhsana, Rashid, Sabina Faiz, Gemechu, Daniel, Otiso, Lilian, Sidat, Mohsin, Theobald, Sally ORCID: https://orcid.org/0000-0002-9053-211X, Taegtmeyer, Miriam ORCID: https://orcid.org/0000-0002-5377-2536 and de Koning, Korrie (2019) 'Salaried and voluntary community health workers: exploring how incentives and expectation gaps influence motivation'. Human Resources for Health, Vol 17, Issue 1, e59.

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Abstract

Background: The recent publication of the WHO guideline on support to optimise community health worker (CHW) programmes illustrates the renewed attention for the need to strengthen the performance of CHWs. Performance partly depends on motivation, which in turn is influenced by incentives. This paper aims to critically
analyse the use of incentives and their link with improving CHW motivation.
Methods: We undertook a comparative analysis on the linkages between incentives and motivation based on existing datasets of qualitative studies in six countries. These studies had used a conceptual framework on factors influencing CHW performance, where motivational factors were defined as financial, material, non-material and intrinsic and had undertaken semi-structured interviews and focus group discussions with CHWs, supervisors,
health managers and selected community members.
Results: We found that (a mix of) incentives influence motivation in a similar and sometimes different way across contexts. The mode of CHW engagement (employed vs. volunteering) influenced how various forms of incentives affect each other as well as motivation. Motivation was negatively influenced by incentive-related “expectation gaps”, including lower than expected financial incentives, later than expected payments, fewer than expected
material incentives and job enablers, and unequally distributed incentives across groups of CHWs. Furthermore, we found that incentives could cause friction for the interface role of CHWs between communities and the health sector.
Conclusions: Whether CHWs are employed or engaged as volunteers has implications for the way incentives influence motivation. Intrinsic motivational factors are important to and experienced by both types of CHWs, yet for many salaried CHWs, they do not compensate for the demotivation derived from the perceived low level of financial reward. Overall, introducing and/or sustaining a form of financial incentive seems key towards strengthening CHW motivation. Adequate expectation management regarding financial and material incentives is essential to prevent frustration about expectation
gaps or “broken promises”, which negatively affect motivation. Consistently receiving the type and amount of incentives
promised appears as important to sustain motivation as raising the absolute level of incentives.
Keywords: Community health workers, Motivation, Remuneration, Incentives, Low- and middle-income countries

Item Type: Article
Subjects: W General Medicine. Health Professions > W 21.5 Allied health personnel. Allied health professions
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WA Public Health > Health Administration and Organization > WA 546 Local Health Administration. Community Health Services
WY Nursing > WY 106 Community health nursing
Faculty: Department: Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1186/s12960-019-0387-z
Depositing User: Rachel Dominguez
Date Deposited: 30 Jul 2019 11:39
Last Modified: 17 Oct 2019 10:52
URI: https://archive.lstmed.ac.uk/id/eprint/11288

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