Sources of community health worker motivation: a qualitative study in Morogoro Region, Tanzania.
Sources of community health worker motivation: a qualitative study in Morogoro Region, Tanzania.
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DOI：
10.1186/1478-4491-11-52
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发表时间：
2013-10-10
影响因子：
4.5
通讯作者：
Winch PJ
中科院分区：
文献类型：
--
作者：
Greenspan JA;McMahon SA;Chebet JJ;Mpunga M;Urassa DP;Winch PJ
在坦桑尼亚，人们对社区卫生工作者（CHW）重新产生了兴趣，但也有人担心，社区卫生工作者的积极性低可能会降低社区卫生工作者项目投资的效益。本研究旨在探讨在坦桑尼亚和类似的环境中，CHW动机的来源，为项目提供信息。我们对坦桑尼亚莫罗戈罗地区的20名卫生保健员进行了半结构化访谈。在翻译和主题分析之前，采访被数字化记录、转录和编码。然后，作者对CHW动机进行了文献综述，并修改了与我们的研究结果一致的框架，以指导结果的呈现。在个人、家庭、社区和组织层面确定了CHW动机的来源。在个人层面上，保健员倾向于志愿工作，并运用所学知识解决自己、家庭和社区的问题。家庭和社区通过提供精神、经济和物质支持（包括服务费、用品、交通费、帮助从事农活和卫生工作）来补充其他动力来源。家庭和社区成员对CHW工作的抵制是有限的。组织层面（政府及其发展伙伴）以津贴、潜在就业机会、材料、培训和监督的形式提供激励，但薪酬和供应不足阻碍了卫生工作者的发展。如果被视为表现不佳的标志，监督也可能会让人失去动力。坦桑尼亚的卫生保健员虽然没有工资，但他们有一种志愿服务的内在愿望，当其他动力来源不足时，他们的动力往往来自家庭的支持。政策制定者和项目经理应该考虑到缺乏报酬给保健女工家庭带来的负担。此外，志愿者的内在愿望并不排除对外部奖励的渴望。相反，适当和正式的财政奖励和实物替代品将使已经有动力的卫生工作者增加他们对工作的承诺。
There is a renewed interest in community health workers (CHWs) in Tanzania, but also a concern that low motivation of CHWs may decrease the benefits of investments in CHW programs. This study aimed to explore sources of CHW motivation to inform programs in Tanzania and similar contexts. We conducted semi-structured interviews with 20 CHWs in Morogoro Region, Tanzania. Interviews were digitally recorded, transcribed, and coded prior to translation and thematic analysis. The authors then conducted a literature review on CHW motivation and a framework that aligned with our findings was modified to guide the presentation of results. Sources of CHW motivation were identified at the individual, family, community, and organizational levels. At the individual level, CHWs are predisposed to volunteer work and apply knowledge gained to their own problems and those of their families and communities. Families and communities supplement other sources of motivation by providing moral, financial, and material support, including service fees, supplies, money for transportation, and help with farm work and CHW tasks. Resistance to CHW work exhibited by families and community members is limited. The organizational level (the government and its development partners) provides motivation in the form of stipends, potential employment, materials, training, and supervision, but inadequate remuneration and supplies discourage CHWs. Supervision can also be dis-incentivizing if perceived as a sign of poor performance. Tanzanian CHWs who work despite not receiving a salary have an intrinsic desire to volunteer, and their motivation often derives from support received from their families when other sources of motivation are insufficient. Policy-makers and program managers should consider the burden that a lack of remuneration imposes on the families of CHWs. In addition, CHWs’ intrinsic desire to volunteer does not preclude a desire for external rewards. Rather, adequate and formal financial incentives and in-kind alternatives would allow already-motivated CHWs to increase their commitment to their work.
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