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Understanding the importance of non-material factors in retaining community health workers in low-income settings: a qualitative case-study in Ethiopia

OBJECTIVES: The motivation and retention of community health workers (CHWs) is a challenge and inadequately addressed in research and policy. We sought to identify factors influencing the retention of CHWs in Ethiopia and ways to avert their exit. DESIGN: A qualitative study was undertaken using in-...

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Autores principales: Arora, Nikita, Hanson, Kara, Spicer, Neil, Estifanos, Abiy Seifu, Keraga, Dorka Woldesenbet, Welearegay, Alemtsehay Tewele, Tela, Freweini Gebrearegay, Hussen, Yemisrach Ahmed, Mandefro, Yordanos Semu, Quaife, Matthew
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7545659/
https://www.ncbi.nlm.nih.gov/pubmed/33033092
http://dx.doi.org/10.1136/bmjopen-2020-037989
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author Arora, Nikita
Hanson, Kara
Spicer, Neil
Estifanos, Abiy Seifu
Keraga, Dorka Woldesenbet
Welearegay, Alemtsehay Tewele
Tela, Freweini Gebrearegay
Hussen, Yemisrach Ahmed
Mandefro, Yordanos Semu
Quaife, Matthew
author_facet Arora, Nikita
Hanson, Kara
Spicer, Neil
Estifanos, Abiy Seifu
Keraga, Dorka Woldesenbet
Welearegay, Alemtsehay Tewele
Tela, Freweini Gebrearegay
Hussen, Yemisrach Ahmed
Mandefro, Yordanos Semu
Quaife, Matthew
author_sort Arora, Nikita
collection PubMed
description OBJECTIVES: The motivation and retention of community health workers (CHWs) is a challenge and inadequately addressed in research and policy. We sought to identify factors influencing the retention of CHWs in Ethiopia and ways to avert their exit. DESIGN: A qualitative study was undertaken using in-depth interviews with the study participants. Interviews were audio-recorded, and then simultaneously translated into English and transcribed for analysis. Data were analysed in NVivo 12 using an iterative inductive-deductive approach. SETTING: The study was conducted in two districts each in the Tigray and Southern Nations, Nationalities and People’s Republic (SNNPR) regions in Ethiopia. Respondents were located in a mix of rural and urban settings. PARTICIPANTS: Leavers of health extension worker (HEW) positions (n=20), active HEWs (n=16) and key informants (n=11) in the form of policymakers were interviewed. RESULTS: We identified several extrinsic and intrinsic motivational factors affecting the retention and labour market choices of HEWs. While financial incentives in the form of salaries and material incentives in the form of improvements to health facility infrastructure, provision of childcare were reported to be important, non-material factors like HEWs’ self-image, acceptance and validation by the community and their supervisors were found to be critical. A reduction or loss of these non-material factors proved to be the catalyst for many HEWs to leave their jobs. CONCLUSION: Our study contributes new empirical evidence to the global debate on factors influencing the motivation and retention of CHWs, by being the first to include job leavers in the analysis. Our findings suggest that policy interventions that appeal to the social needs of CHWs can prove to be more acceptable and potentially cost-effective in improving their retention in the long run. This is important for government policymakers in resource constrained settings like Ethiopia that rely heavily on lay workers for primary healthcare delivery.
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spelling pubmed-75456592020-10-19 Understanding the importance of non-material factors in retaining community health workers in low-income settings: a qualitative case-study in Ethiopia Arora, Nikita Hanson, Kara Spicer, Neil Estifanos, Abiy Seifu Keraga, Dorka Woldesenbet Welearegay, Alemtsehay Tewele Tela, Freweini Gebrearegay Hussen, Yemisrach Ahmed Mandefro, Yordanos Semu Quaife, Matthew BMJ Open Health Policy OBJECTIVES: The motivation and retention of community health workers (CHWs) is a challenge and inadequately addressed in research and policy. We sought to identify factors influencing the retention of CHWs in Ethiopia and ways to avert their exit. DESIGN: A qualitative study was undertaken using in-depth interviews with the study participants. Interviews were audio-recorded, and then simultaneously translated into English and transcribed for analysis. Data were analysed in NVivo 12 using an iterative inductive-deductive approach. SETTING: The study was conducted in two districts each in the Tigray and Southern Nations, Nationalities and People’s Republic (SNNPR) regions in Ethiopia. Respondents were located in a mix of rural and urban settings. PARTICIPANTS: Leavers of health extension worker (HEW) positions (n=20), active HEWs (n=16) and key informants (n=11) in the form of policymakers were interviewed. RESULTS: We identified several extrinsic and intrinsic motivational factors affecting the retention and labour market choices of HEWs. While financial incentives in the form of salaries and material incentives in the form of improvements to health facility infrastructure, provision of childcare were reported to be important, non-material factors like HEWs’ self-image, acceptance and validation by the community and their supervisors were found to be critical. A reduction or loss of these non-material factors proved to be the catalyst for many HEWs to leave their jobs. CONCLUSION: Our study contributes new empirical evidence to the global debate on factors influencing the motivation and retention of CHWs, by being the first to include job leavers in the analysis. Our findings suggest that policy interventions that appeal to the social needs of CHWs can prove to be more acceptable and potentially cost-effective in improving their retention in the long run. This is important for government policymakers in resource constrained settings like Ethiopia that rely heavily on lay workers for primary healthcare delivery. BMJ Publishing Group 2020-10-08 /pmc/articles/PMC7545659/ /pubmed/33033092 http://dx.doi.org/10.1136/bmjopen-2020-037989 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/ https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle Health Policy
Arora, Nikita
Hanson, Kara
Spicer, Neil
Estifanos, Abiy Seifu
Keraga, Dorka Woldesenbet
Welearegay, Alemtsehay Tewele
Tela, Freweini Gebrearegay
Hussen, Yemisrach Ahmed
Mandefro, Yordanos Semu
Quaife, Matthew
Understanding the importance of non-material factors in retaining community health workers in low-income settings: a qualitative case-study in Ethiopia
title Understanding the importance of non-material factors in retaining community health workers in low-income settings: a qualitative case-study in Ethiopia
title_full Understanding the importance of non-material factors in retaining community health workers in low-income settings: a qualitative case-study in Ethiopia
title_fullStr Understanding the importance of non-material factors in retaining community health workers in low-income settings: a qualitative case-study in Ethiopia
title_full_unstemmed Understanding the importance of non-material factors in retaining community health workers in low-income settings: a qualitative case-study in Ethiopia
title_short Understanding the importance of non-material factors in retaining community health workers in low-income settings: a qualitative case-study in Ethiopia
title_sort understanding the importance of non-material factors in retaining community health workers in low-income settings: a qualitative case-study in ethiopia
topic Health Policy
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7545659/
https://www.ncbi.nlm.nih.gov/pubmed/33033092
http://dx.doi.org/10.1136/bmjopen-2020-037989
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