International Division, John Snow Research and Training Institute, Inc., Addis Ababa, Ethiopia.
John Snow Research and Training Institute, Inc., Fenot Project, Bole Sub City, Woreda 03/05, House No. 2347, PO Box 1988, 1250, Addis Ababa, Ethiopia.
Hum Resour Health. 2018 Nov 8;16(1):57. doi: 10.1186/s12960-018-0319-3.
The use of community health workers (CHWs) has been considered as one of the strategies to address the growing shortage of health workers, predominantly in low-income countries. They are playing a pivotal role in lessening health disparities through improving health outcomes for underserved populations. Yet, little is known about what factors motivate and drive them to continue working as CHWs. In this study, we aimed to examine factors contributing to the motivation of volunteer CHWs (vCHWs) in Ethiopia currently known as one-to-five network leaders (1to5NLs) and explore variations between attributes of social and work-related determinants.
We conducted a cross-sectional study in four selected woredas (the second lowest administrative structure in Ethiopia, and similar to a district) of Oromia and Tigray regions and interviewed 786 1to5NLs. The effects of each motivational factor were explored using percentage of respondents who agreed and strongly agreed to each of them and Mann-Whitney U test.
Individual, community, and health system factors contributed to the motivation of 1to5NLs in this study. Intrinsic desire to have a good status in the community as a result of their volunteer service (81.86%) followed by a commitment to serve the community (81.61%) and to gain satisfaction by accomplishing something worthwhile to the community (81.61%) were some of the factors motivating 1to5NLs in our study. Despite these motivational items, factors such as lack of career development (51.47%), unclear health development army guideline (59.26%), limited supervision and support (62.32%), and lack of recognition and appreciation of accomplishments (63.22%) were the factors negatively affecting motivation of 1to5NLs. Lack of career development, limited supervision and support, and lack of recognition and appreciation of accomplishments were significantly varied between attributes of educational level, marital status, service year as 1to5NLs, and previous volunteer engagement (at P < 0.05).
Findings of our study indicated that non-financial incentives such as the creation of career development models is the key to motivating and retaining CHWs where they are not receiving stipends. Sustainability of CHW program should consider exploring enhanced innovations to strengthen supportive supervision, development of better mechanisms to publicize the role of CHWs, and improvement of recognition and appreciation schemes for CHWs' efforts and accomplishments.
在解决卫生工作者短缺问题方面，人们一直认为使用社区卫生工作者（CHW）是一种策略，主要在低收入国家。他们通过改善服务不足人群的健康结果，在减少健康差距方面发挥着关键作用。然而，人们对促使和推动他们继续作为 CHW 工作的因素知之甚少。在这项研究中，我们旨在研究目前在埃塞俄比亚被称为 1 对 5 网络领导者（1to5NLs）的志愿 CHW（vCHW）的激励因素，并探讨社会和工作相关决定因素属性之间的差异。
我们在奥罗米亚和提格雷地区的四个选定的沃里德（埃塞俄比亚的第二低行政结构，类似于区）进行了横断面研究，并对 786 名 1to5NLs 进行了访谈。使用受访者对每个激励因素的同意和强烈同意的百分比来探索每个激励因素的影响，并使用 Mann-Whitney U 检验。
个体、社区和卫生系统因素促成了本研究中 1to5NLs 的积极性。由于他们的志愿服务，在社区中获得良好地位的内在愿望（81.86%），其次是为社区服务的承诺（81.61%）以及通过完成对社区有价值的事情获得满足感（81.61%）是激励我们研究中的 1to5NLs 的一些因素。尽管存在这些激励因素，但一些因素，如缺乏职业发展（51.47%）、不明确的卫生发展军指导方针（59.26%）、有限的监督和支持（62.32%）以及缺乏对成就的认可和赞赏（63.22%），这些因素对 1to5NLs 的积极性产生了负面影响。职业发展的缺乏、监督和支持的有限，以及对成就的认可和赞赏的缺乏，在教育水平、婚姻状况、作为 1to5NLs 的服务年限和以前的志愿参与等属性之间存在显著差异（P < 0.05）。
我们的研究结果表明，非经济激励措施，如创建职业发展模式，是激励和留住 CHW 的关键，因为他们没有获得津贴。CHW 计划的可持续性应考虑探索增强创新，以加强支持性监督，制定更好的机制来宣传 CHW 的作用，并改进对 CHW 努力和成就的认可和赞赏计划。
