Health Systems Science, George Institute for Global Health, Sydney, New South Wales, Australia
Public Administration, Brawijaya University, Malang, Indonesia.
BMJ Glob Health. 2022 Aug;7(8). doi: 10.1136/bmjgh-2022-008936.
Community health workers (CHWs) play a critical role in supporting health systems, and in improving accessibility to primary healthcare. In many settings CHW programmes do not have formalised employment models and face issues of high attrition and poor performance. This study aims to determine the employment preferences of CHWs in Malang district, Indonesia, to inform policy interventions.
A discrete choice experiment was conducted with 471 CHWs across 28 villages. Attributes relevant to CHW employment were identified through a multistage process including literature review, focus group discussions and expert consultation. Respondents' choices were analysed with a mixed multinomial logit model and latent class analyses.
Five attributes were identified: (1) supervision; (2) training; (3) monthly financial benefit; (4) recognition; and (5) employment structure. The most important influence on choice of job was a low monthly financial benefit (US$2) (β=0.53, 95% CI=0.43 to 0.63), followed by recognition in the form of a performance feedback report (β=0.13, 95% CI=0.07 to 0.20). A large monthly financial benefit (US$20) was most unappealing to respondents (β=-0.13, 95% CI=-0.23 to -0.03). Latent class analysis identified two groups of CHWs who differed in their willingness to accept either job presented and preferences over specific attributes. Preferences diverged based on respondent characteristics including experience, hours' worked per week and income.
CHWs in Malang district, Indonesia, favour a small monthly financial benefit which likely reflects the unique cultural values underpinning the programme and a desire for remuneration that is commensurate with the limited number of hours worked. CHWs also desire enhanced methods of performance feedback and greater structure around training and their rights and responsibilities. Fulfilling these conditions may become increasingly important should CHWs work longer hours.
社区卫生工作者（CHW）在支持卫生系统和提高初级医疗保健可及性方面发挥着关键作用。在许多情况下，CHW 计划没有正式的就业模式，并面临高离职率和绩效不佳的问题。本研究旨在确定印度尼西亚马朗地区 CHW 的就业偏好，为政策干预提供信息。
对 28 个村庄的 471 名 CHW 进行了离散选择实验。通过文献回顾、焦点小组讨论和专家咨询等多阶段过程确定了与 CHW 就业相关的属性。使用混合多项逻辑回归模型和潜在类别分析对受访者的选择进行分析。
确定了五个属性：（1）监督；（2）培训；（3）每月经济利益；（4）认可；（5）就业结构。对工作选择影响最大的因素是每月经济利益低（约 2 美元）（β=0.53，95%CI=0.43 至 0.63），其次是绩效反馈报告形式的认可（β=0.13，95%CI=0.07 至 0.20）。高每月经济利益（约 20 美元）对受访者最没有吸引力（β=-0.13，95%CI=-0.23 至 -0.03）。潜在类别分析确定了两组 CHW，他们在接受提供的工作和对特定属性的偏好方面存在差异。偏好的差异基于受访者的特征，包括经验、每周工作小时数和收入。
印度尼西亚马朗地区的 CHW 倾向于小额的每月经济利益，这可能反映了该计划背后独特的文化价值观以及与工作时间有限相称的薪酬愿望。CHW 还希望增强绩效反馈方法，并在培训以及他们的权利和责任方面提供更大的结构。如果 CHW 工作时间更长，满足这些条件可能变得越来越重要。
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