Motivation of Community Health Volunteers in rural Uganda: the interconnectedness of knowledge, relationship and action

Abstract

Objectives: In some countries, full-time Community Health Workers (CHWs) have contributed to improvements in under-5 morbidity and mortality. Based on these successes, other low- and middle-income countries are in the process of reconsidering their current health care delivery systems and integrating CHWs as a means by which to fill the gaps. It may be important to make the distinction between CHWs and Community Health Volunteers (CHVs), both of which have a unique but complementary role. While remuneration in motivation of CHWs has been extensively discussed in the literature, other motivators that may prevent high attrition rates amongst volunteers have gained less attention. The objective of this study was to understand whether full-time professional CHWs can potentially work with volunteers in the community to widen their reach and scope and if so what motivators might be of key importance to the CHVs remaining active in the field.

Study design: CHVs were selected and trained in eight villages in East Uganda as part of a mixed-method trial conducted between March 2014 and February 2015.

Methods: Eight to twelve CHVs from each village were trained by CHWs to make home-visits to pregnant women and newborn babies and to improve hygiene. This paper reports on a) demographic data about CHVs (n = 81) and; b) in-depth interviews with retained CHVs (n = 81).

Results: There was a 95% retention rate amongst CHVs. In-depth interviews showed that acquisition and sharing of knowledge, relationship building and seeing health-related knowledge put into action were more important motivators than the transport allowances or the hope of gaining employment. Additionally, CHVs put what they learnt into practice by building tippy taps, having dish-racks and purifying water in their homes and as such were role models in the community.

Conclusion: CHVs can be retained and motivated by factors other than remuneration. Gaining and sharing of knowledge with community members, relationship building and community action were inter-related and ranked higher by CHVs as motivators than the hope of employment or the transport allowance.

Keywords: Accompaniment; Community Health volunteers; Community Health workers; Empowerment; Maternal and newborn health; Neonatal health; Pregnancy; Supportive supervision.