Qualitative assessment of community health workers' perspective on their motivation in community-based primary health care in rural Malawi

Myness Kasanda Ndambo; Fabien Munyaneza; Moses Banda Aron; Basimenye Nhlema; Emilia Connolly

doi:10.1186/s12913-022-07558-6

Qualitative assessment of community health workers' perspective on their motivation in community-based primary health care in rural Malawi

BMC Health Serv Res. 2022 Feb 11;22(1):179. doi: 10.1186/s12913-022-07558-6.

Authors

Myness Kasanda Ndambo¹, Fabien Munyaneza², Moses Banda Aron², Basimenye Nhlema^#², Emilia Connolly^#^{2

3

4}

Affiliations

¹ Partners In Health/Abwenzi Pa Za Umoyo, PO Box 56, Neno, Blantyre, Malawi. mynessndambo@yahoo.com.
² Partners In Health/Abwenzi Pa Za Umoyo, PO Box 56, Neno, Blantyre, Malawi.
³ Division of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH, 45267, USA.
⁴ Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45529, USA.

^# Contributed equally.

Abstract

Background: Community Health Workers (CHWs) have a positive impact on the provision of community-based primary health care through screening, treatment, referral, psychosocial support, and accompaniment. With a broad scope of work, CHW programs must balance the breadth and depth of tasks to maintain CHW motivation for high-quality care delivery. Few studies have described the CHW perspective on intrinsic and extrinsic motivation to enhance their programmatic activities.

Methods: We utilized an exploratory qualitative study design with CHWs employed in the household model in Neno District, Malawi, to explore their perspectives on intrinsic and extrinsic motivators and dissatisfiers in their work. Data was collected in 8 focus group discussions with 90 CHWs in October 2018 and March-April 2019 in seven purposively selected catchment areas. All interviews were audiotaped, transcribed verbatim, coded, and analyzed using Dedoose.

Results: Themes of complex intrinsic and extrinsic factors were generated from the perspectives of the CHWs in the focus group discussions. Study results indicate that enabling factors are primarily intrinsic factors such as positive patient outcomes, community respect, and recognition by the formal health care system but can lead to the challenge of increased scope and workload. Extrinsic factors can provide challenges, including an increased scope and workload from original expectations, lack of resources to utilize in their work, and rugged geography. However, a positive work environment through supportive relationships between CHWs and supervisors enables the CHWs.

Conclusion: This study demonstrated enabling factors and challenges for CHW performance from their perspective within the dual-factor theory. We can mitigate challenges through focused efforts to limit geographical distance, manage workload, and strengthen CHW support to reinforce their recognition and trust. Such programmatic emphasis can focus on enhancing motivational factors found in this study to improve the CHWs' experience in their role. The engagement of CHWs, the communities, and the formal health care system is critical to improving the care provided to the patients and communities, along with building supportive systems to recognize the work done by CHWs for the primary health care systems.

Keywords: Community health worker (CHW); Community-based health care; Motivation; Primary health care.

MeSH terms

Community Health Workers*
Humans
Malawi
Motivation*
Primary Health Care
Qualitative Research