Understanding Factors That Support Community Health Worker Motivation, Job Satisfaction, and Performance in Three Ugandan Districts: Opportunities for Strengthening Uganda’s Community Health Worker Program

Document Type : Original Article

Authors

1 Department of International Health, the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

2 Population Council, Nairobi, Kenya

3 Last Mile Health, Kampala, Uganda

4 Population Council, Washington, DC, USA

Abstract

Background 
Uganda’s community health worker (CHW) program experiences several challenges related to the appropriate motivation, job satisfaction, and performance of the CHW workforce. This study aims to identify barriers in the effective implementation of financial and non-financial incentives to support CHWs and to strengthen Uganda’s CHW program.

Methods 
The study was implemented in Uganda’s Lira, Wakiso, and Mayuge districts in May 2019. Ten focus group discussions (FGDs) were held with 91 CHWs, 17 in-depth interviews (IDIs) were held with CHW supervisors, and 7 IDIs were held with policy-level stakeholders. Participants included stakeholders from both the Ugandan government and non-governmental organizations (NGOs). Utilizing a thematic approach, themes around motivation, job satisfaction, incentive preferences, and CHW relationships with the community, healthcare facilities, and government were analyzed.
 
Results 
CHWs identified a range of factors that contributed to their motivation or demotivation. Non-monetary factors included recognition from the health system and community, access to transportation, methods for identification as a healthcare worker, provision of working tools, and training opportunities. Monetary factors included access to monthly stipends, transportation-related refunds, and timely payment systems to reduce refund delays to CHWs. Additionally, CHWs indicated wanting to be considered for recruitment into the now-halted rollout of a salaried CHW cadre, given the provision of payment.

Conclusion 
It is imperative to consider how to best support the current CHW program prior to the introduction of new cadres, as it can serve to exacerbate tensions between cadres and further undermine provision of community health. Providing a harmonized, balanced, and uniform combination of both monetary incentives with non-monetary incentives is vital for effective CHW programs.

Keywords


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Articles in Press, Corrected Proof
Available Online from 03 April 2022
  • Receive Date: 24 May 2021
  • Revise Date: 23 March 2022
  • Accept Date: 30 March 2022
  • First Publish Date: 03 April 2022