The female community health volunteer programme in Nepal: Decision makers' perceptions of volunteerism, payment and other incentives
The female community health volunteer programme in Nepal: Decision makers' perceptions of volunteerism, payment and other incentives
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DOI：
10.1016/j.socscimed.2010.02.034
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发表时间：
2010-06-01
影响因子：
5.4
通讯作者：
Shrestha, Vijaya
中科院分区：
文献类型：
--
作者：
Glenton, Claire;Scheel, Inger B.;Shrestha, Vijaya
尼泊尔的女性社区保健志愿人员方案自1980年代末以来一直存在，包括近5万名志愿人员。尽管人们普遍认为志愿者项目的特点是人员流失率高，但FCHV项目每年的志愿者流失率不到5%。决策者对社区卫生工作者动机的了解程度以及将这些动机与适当的激励措施相匹配的程度可能会影响方案的可持续性。本研究的目的是探讨参与女性社区卫生志愿者设计与实施的利益相关者对志愿者动机和适当激励的看法，并将这些观点与志愿者的观点和期望进行比较。2009年进行了半结构化访谈，有目的地选择了19名非志愿者利益相关者，包括政策制定者和项目经理。结果比较了先前对女性社区卫生志愿者的研究数据以及对四名志愿者和两名志愿者积极分子的采访。利益相关者认为志愿者的主要动机是社会尊重、宗教和道德责任。在空闲时间提供服务的自由被视为志愿者概念的核心。虽然利益相关者也看到了小额信贷等外部激励的必要性，但常规工资不仅在经济上不可行，而且可能威胁到志愿者的社会尊重，从而影响他们的积极性。这些观点反映在对女性社区卫生志愿人员的采访和以前的研究中，似乎受到志愿服务作为道德行为的传统、对受薪政府工作人员缺乏尊重以及该方案的社区嵌入性的影响。我们的研究表明，推广一种通用的激励措施（如工资）来提高社区卫生工作者计划的可持续性可能是没有用的。相反，如果要实现低流失率和高绩效，规划应确保社区卫生工作者、规划管理人员和决策者对具体情况的期望保持一致。(C) 2010 Elsevier Ltd.版权所有。
The Female Community Health Volunteer (FCHV) Programme in Nepal has existed since the late 1980s and includes almost 50,000 volunteers. Although volunteer programmes are widely thought to be characterised by high attrition levels, the FCHV Programme loses fewer than 5% of its volunteers annually. The degree to which decision makers understand community health worker motivations and match these with appropriate incentives is likely to influence programme sustainability. The purpose of this study was to explore the views of stakeholders who have participated in the design and implementation of the Female Community Health Volunteer regarding Volunteer motivation and appropriate incentives, and to compare these views with the views and expectations of Volunteers. Semi-structured interviews were carried out in 2009 with 19 purposively selected non-Volunteer stakeholders, including policy makers and programme managers. Results were compared with data from previous studies of Female Community Health Volunteers and from interviews with four Volunteers and two Volunteer activists. Stakeholders saw Volunteers as motivated primarily by social respect, religious and moral duty. The freedom to deliver services at their leisure was seen as central to the volunteer concept. While stakeholders also saw the need for extrinsic incentives such as micro-credit, regular wages were regarded not only as financially unfeasible, but as a potential threat to the Volunteers' social respect, and thereby to their motivation. These views were reflected in interviews with and previous studies of Female Community Health Volunteers, and appear to be influenced by a tradition of volunteering as moral behaviour, a lack of respect for paid government workers, and the Programme's community embeddedness. Our study suggests that it may not be useful to promote a generic range of incentives, such as wages, to improve community health worker programme sustainability. Instead, programmes should ensure that the context-specific expectations of community health workers, programme managers, and policy makers are in alignment if low attrition and high performance are to be achieved. (C) 2010 Elsevier Ltd. All rights reserved.