Panday Sarita, Teijlingen Edwin van, Barnes Amy
School of Health and Social Care, University of Essex, Colchester, United Kingdom.
Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, United Kingdom.
PLOS Glob Public Health. 2024 Aug 1;4(8):e0003428. doi: 10.1371/journal.pgph.0003428. eCollection 2024.
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.
激励社区卫生工作者（CHW）——其中许多是志愿者——对于在资源匮乏地区实现初级卫生保健（PHC）的全民健康覆盖（UHC）至关重要。在尼泊尔农村地区，初级卫生保健主要由女性社区卫生工作者提供，当地称为女性社区健康志愿者（FCHV），但人们对她们了解甚少。本文探讨了影响女性社区健康志愿者积极性的经验因素，包括积极性如何与妇女的生计相互关联，并思考这对尼泊尔乃至全球实现初级卫生保健意味着什么。我们在尼泊尔的山区和特莱（与印度接壤的平原地区）进行了定性研究。通过31次半结构化访谈（20名志愿者、11名当地带薪卫生工作者）以及与另外15名志愿者进行的三次焦点小组讨论，有目的地收集了数据。所有访谈均进行了录音，逐字转录为尼泊尔语并翻译成英语。使用NVivo10对数据进行编码，在个人、组织和社区层面进行主题分析。女性社区健康志愿者的志愿服务动机受到多方面影响。在个人层面，参与者渴望并致力于志愿工作，但志愿服务的机会成本、自付费用以及家庭支持不足使许多本已负担过重的女性倍感压力。在社区层面，社区成员将志愿者视为带薪卫生工作者，认为对志愿者的努力缺乏认可，这削弱了女性社区健康志愿者的志愿服务动机。最后，在组织层面，官僚主义对记录和报告的强调，以及当地卫生工作者缺乏尊重，削弱了她们的工作积极性。我们的论文表明，一些背景最贫困的女性社区健康志愿者可能极具志愿服务的积极性，但个人、组织和社区层面社会和经济支持的不足削弱了这种积极性、她们生计的安全性，进而影响了实现初级卫生保健的更广泛努力。需要进行财政投资以补偿女性社区健康志愿者，使她们保持为实现初级卫生保健的全球健康目标而努力的积极性。
