The influence of incentives on community health worker motivation in the provision of family planning. A case of Msalala and Shinyanga Districts, Tanzania

Community health workers (CHWs) are essential in the provision of a wide range of services, including family planning. In Tanzania, deployment of CHWs has largely been supported by non-governmental organizations (NGOs) who often determine their incentives. A mix of incentives is required to increase CHW motivation and, ultimately, performance. This qualitative study aimed to explore how incentives influence CHW motivation in the provision of family planning services in Msalala and Shinyanga districts. The study included focus group discussions and in-depth interviews with 21 CHWs, 12 supervisors and eight policy makers and NGO representatives. Transcripts were coded and narratives were written on types of incentives, motivating and demotivating factors. The study revealed that although CHW motivation was related to feelings of accomplishment and respect from the community, financial incentives were found equally important for motivation. While most CHWs received non-financial incentives, CHWs had unequal access to financial incentives. Key informants confirmed that there was no coordination on incentives at district level. Some CHWs reported demotivation because of misconceptions and unacceptance of family planning in the community and irregular supply of contraceptives. Results from this study show that motivation of voluntary CHWs in Msalala and Shinyanga districts is currently sub-optimal, because of inequity in access to (financial) incentives. There is a need for better coordination and standardization of CHW incentives. Advocacy is needed to increase funding for CHWs’ deployment and remuneration. This would increase CHW motimotivation and ultimately performance, also in the field of family planning.

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Psychiatric symptoms among migrants to Malaysia from the southernmost provinces of Thailand

International Journal of Social Psychiatry ◽

10.1177/0020764021989736 ◽

2021 ◽

pp. 002076402198973

Author(s):

Kathleen Ford ◽

Aree Jampaklay ◽

Aphichat Chamatrithirong

Keyword(s):

Mental Health ◽

Psychiatric Symptoms ◽

Well Being ◽

Policy Makers ◽

Governmental Organizations ◽

Non Governmental Organizations ◽

Working Age ◽

Self Reporting Questionnaire ◽

Depth Interviews ◽

Migrant Groups

Aim: The objective of this paper is to examine the level of psychiatric symptoms and associated factors among Thai migrants from the southernmost Thai provinces of Pattani, Yala, and Narithiwat who are working in Malaysia. Comparisons will be made with the sending population in the southernmost provinces of Thailand. Methods: Data are drawn from survey and in-depth interviews with Thai migrants who are working in Malaysia. Comparisons are made with a probability sample of working age adults in Thailand. The twenty item Self Reporting Questionnaire (SRQ) was the measure of mental health. Results: The study found that the migrants, on average, have normal levels of psychiatric symptoms. However, although about 24% of migrants reported more eight or more symptoms that may indicate a need for evaluation. There are many stressors in their lives including distance from families, reduced social support, legal matters surrounding immigration, and discrimination/exploitation of migrant groups. Conclusion: The study highlights the need for policy makers and non-governmental organizations to give attention to migrants’ mental health, well-being and sustainable livelihoods.

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Needs Assessment of Community Health Workers to enhance efficient delivery of their services for Community Case Management of Malaria in Kenya

10.21203/rs.3.rs-20695/v2 ◽

2021 ◽

Author(s):

Michelle D. S. Boakye ◽

Collins J. Owek ◽

Elizabeth Oluoch ◽

Sefa Bonsu Atakora ◽

Juddy Wachira ◽

...

Keyword(s):

Case Management ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Community Case Management ◽

Group Discussions ◽

Key Informants ◽

Efficient Delivery ◽

Study Participants ◽

Depth Interviews

Abstract BackgroundMalaria continues to be the leading cause of morbidity and mortality in Africa. Community Case Management of malaria (CCMm) through engaging Community Health Workers (CHWs) to effectively address management of malaria cases in some endemic communities was explored in this study. We assessed the needs of CHWs that would help sustain and retain their services to enhance the efficient delivery of CCMm. MethodsData on the needs of CHWs was gathered through a qualitative study consisting of in-depth interviews and focus group discussions (FGDs) conducted among study participants in five districts in western Kenya using a semi-structured questionnaire. The study participants comprised of 100 CHWs, 100 mothers of children under five years and 25 key informants made up of public health officers and clinicians involved in the CCMm. The interviews were conducted in English and Swahili or Dholuo, the local language. The recorded audio interviews were transcribed later. The analysis was done using NVivo version 7 software and transcripts were coded after which themes related to the objectives of the study were identified.ResultsAll the study participants recognized the need to train and update CHWs on their work as well as remunerating them for their services to enhance efficient delivery of services. The CHWs on their part perceived the provision of gloves, RDTs, lancets, cotton wool and ethanol, bins (to dispose of RDTs and lancets), together with drugs for treating clients as their essential needs to undertake CCMm in the communities. Other logistical needs and incentives mentioned by CHWs and key informants for the successful delivery of CCMm included: gumboots, raincoats, torch lights, mobile phones, means of transportation (bicycles and motorbikes), uniforms and ID cards for identification. ConclusionCHWs would perform tasks better and their services retained for a sustainable CCMm if properly incentivized, offered refresher trainings (and updates) on malaria and equipped with the requisite tools identified in this study.

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Means, Motives and Opportunity: determinants of community health worker performance

BMJ Global Health ◽

10.1136/bmjgh-2019-001790 ◽

2019 ◽

Vol 4 (5) ◽

pp. e001790 ◽

Cited By ~ 3

Author(s):

Aparna John ◽

Thomas Newton-Lewis ◽

Shuchi Srinivasan

Keyword(s):

Community Health ◽

Health Workers ◽

Policy Makers ◽

Individual Level ◽

Wide Range ◽

Worker Performance ◽

Performance Problem ◽

The Individual ◽

Job Role

The performance of community health workers (CHWs) typically depends on the interaction between their motivation (their intent to achieve personal and organisational goals) and the constraints that they face in doing so. These constraints can be both at the individual level, for example, whether the worker has the skills and knowledge required to deliver on their job role, and the organisational level, for example, whether the worker is provided with the resources required to perform. Designing interventions to improve the performance of CHWs requires identifying the constraints to performance in a particular context. Existing frameworks on CHW performance tend to be derived empirically, identifying a broad range of intervention design and contextual factors that have been shown to influence CHW performance. These may not always be able to guide policy makers to identify the precise cause of a specific performance problem in a particular context and develop an appropriate policy response. This article presents a framework to help practitioners and researchers diagnose the constraints to performance of CHWs and guide programmatic and policy responses. The Means, Motives and Opportunity (MMO) framework has been adapted from the SaniFOAM framework used to identify the determinants of sanitation behaviours. It is based on three interdependent and interacting domains: means (whether an individual is capable of performing), motives (whether an individual wants to perform) and opportunity (whether the individual has the chance to perform). A wide range of data sources are expected to be used when applying the MMO framework, especially qualitative research that captures the perspectives and lived realities of CHWs and their communities. In this article, we demonstrate how the MMO framework can be applied to identify the constraints to CHW performance using the case study of Anganwadi Workers (village nutrition workers) in Bihar, India.

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Nutritional Influences on the Health of Women and Children in Cabo Delgado, Mozambique: A Qualitative Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17176205 ◽

2020 ◽

Vol 17 (17) ◽

pp. 6205

Author(s):

Adelaide Lusambili ◽

Violet Naanyu ◽

Gibson Manda ◽

Lindsay Mossman ◽

Stefania Wisofschi ◽

...

Keyword(s):

Acute Malnutrition ◽

Group Discussions ◽

Pregnant Adolescent ◽

Governmental Organizations ◽

Non Governmental Organizations ◽

Micronutrient Powder ◽

Wide Range ◽

Nutritional Influences ◽

The Government ◽

Gender Knowledge

In 2017, the Government of Mozambique declared localized acute malnutrition crises in a range of districts across Mozambique including Cabo Delgado. This is in spite of intensive efforts by different non-governmental organizations (NGO) and the Government of Mozambique to expand access to information on good nutritional practices as well as promote nutrition-specific interventions, such as cooking demonstrations, home gardens and the distribution of micronutrient powder to children. This paper examines and discusses key nutritional influences on the health of pregnant and breastfeeding mothers in Cabo Delgado province, Mozambique. We conducted 21 key informant interviews (KIIs) with a wide range of stakeholders and 16 in-depth interviews (IDIs) with women. In addition, we conducted four focus group discussions with each of the following groups: (1) pregnant adolescent girls, (2) pregnant women >20 yrs, (3) women >20 yrs with babies <6 mths who were not practicing exclusive breastfeeding, (4) women >20 yrs of children <2 yrs and (5) with fathers of children <2 yrs. Data were analyzed thematically using NVIVO software. There is no single widely held influence on pregnant and breast-feeding women’s nutritional decision-making, choices and food consumption. Rather, variables such as social-cultural, environmental, economic, gender, knowledge and information intersect in their roles in nutritional food choices.

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Gender Intentional Approaches to Enhance Health Social Enterprises in Africa: A Qualitative Study of Constraints and Strategies

10.21203/rs.3.rs-69354/v1 ◽

2020 ◽

Author(s):

Kevin McKague ◽

Sarah Harrison ◽

Jenipher Musoke

Keyword(s):

Focus Group ◽

Health Outcomes ◽

Community Health ◽

Gender Equality ◽

Financial Incentives ◽

Social Enterprises ◽

Gender Integration ◽

Governmental Organizations ◽

Non Governmental Organizations ◽

Gender Based

Abstract Background: Health social enterprises are experimenting with community health worker (CHW) models that allow for various income-generating opportunities to motivate and incentivize CHWs. Although evidence shows that improving gender equality contributes to the achievement of health outcomes, gender-based constraints faced by CHWs working with social enterprises in Africa have not yet been empirically studied. This study is the first of its kind to address this important gap in knowledge. Methods: We conducted 30 key informant interviews and 21 focus group discussions between 2016 and 2020 (for a total of 175 individuals: 106 women and 69 men) with four health social enterprises in Uganda and Kenya and other related key stakeholders and domain experts. Interview and focus group transcripts were coded according to gender-based constraints and strategies for enhanced performance as well as key sites for intervention. Results: We found that CHW programs can be more gender responsive. We introduce the Gender Integration Continuum for Health Social Enterprises as a tool that can help guide gender equality efforts. Data revealed female CHWs face seven unique gender-based constraints (compared to male CHWs): higher time burden and lack of economic empowerment; risks to personal safety; lack of career advancement and leadership opportunities; lack of access to needed equipment, medicines and transport; lack of access to capital; lack of access to social support and networking opportunities; and insufficient financial and non-financial incentives. Data also revealed four key areas of intervention: the health social enterprise, the CHW, the CHW’s partner, and the CHW’s patients. In each of the four areas, gender responsive strategies were identified to overcome constraints and contribute to improved gender equality and community health outcomes. Conclusions: This is the first study of its kind to identify the key gender-based constraints and gender responsive strategies for health social enterprises in Africa using CHWs. Findings can assist organizations working with CHWs in Africa (social enterprises, governments or non-governmental organizations) to develop gender responsive strategies that increase the gender and health outcomes while improving gender equality for CHWs, their families, and their communities.

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Preventing Child Marriage: The Role of Strategic Actors in South Kalimantan

Jurnal Antropologi Isu-Isu Sosial Budaya ◽

10.25077/jantro.v23.n1.p110-117.2021 ◽

2021 ◽

Vol 23 (1) ◽

pp. 110

Author(s):

Vinita Susanti ◽

Reni Kartikawati ◽

Irwan M Hidayana ◽

Ida Ruwaida ◽

Lusiana Rumintang

Keyword(s):

Child Protection ◽

Child Marriage ◽

Group Discussions ◽

Policy Makers ◽

Governmental Organizations ◽

Non Governmental Organizations ◽

Depth Interview ◽

Key Policy ◽

Negative Impacts

South Kalimantan Province is the province with the highest number of child marriage cases, according to data from the Central Statistics Agency (BPS) in 2017 and 2019. This has resulted in various negative impacts, one of which is the high maternal mortality rate, as well as the low human development index (HDI) in the province, which is placed at the 22nd position from 34 provinces in Indonesia. This paper aims to examine various strategic actors who can prevent and reduce the practice of child marriage in South Kalimantan Province in three levels of analysis: the macro, mezzo, and micro levels. This paper seeks the relationship between the three aspects of structure, culture, and social processes at the three macro, mezzo, and micro levels, as the concept of analysis used to prevent child marriage practices from a child protection perspective and SRHR issues. This study uses a qualitative approach through in-depth interview methods to key policy makers and is supported by focus group discussions (FGD) to participants in discussions from various backgrounds, both government agencies, and non-governmental organizations concerned with the issue of child and women's protection in South Kalimantan Province.

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Is induced abortion becoming a family planning method in Ghana?: A situational analysis of induce abortion and contraception uptake in two urban cities of Ghana

10.36811/ijrmsh.2019.110002 ◽

2019 ◽

pp. 08-23

Author(s):

Fred Yao Gbagbo ◽

Josephine Akosua Gbagbo

Keyword(s):

Family Planning ◽

Induced Abortion ◽

Situational Analysis ◽

Cross Sectional ◽

Abortion Law ◽

On Demand ◽

Governmental Organizations ◽

Non Governmental Organizations ◽

Post Abortion ◽

Depth Interviews

Background: Following amendment of Ghanaian abortion law in 1985, abortion services became more available as permitted by law. Services data however remain scares due to provider and facility stigmatization. Objective: To explore the use of abortion as a family planning option using provider reports, trends of contraception and induced abortion service uptake in facilities within two urban cities in Ghana. Methods: Cross-sectional, descriptive design, using facility data from 50 private (42) and Non-Governmental Organizations (8). Ten in-depth interviews were also held with midwife providers (6) and medical officers (4) between January 2010 and December 2017 in Accra and Kumasi Metropolises. Results: Facility patronage of abortion services in Accra and Kumasi Metropolises increase steadily each year with contraception uptake. Abortion services in NGO facilities were however reported as target driven and providers’ performances/bonuses were tied to meeting set targets thereby encouraging abortion on demand. Whereas NGO facilities provide both abortion and full contraception method mix, majority (38 out of 42) of private facilities provide only abortion services. Those providing contraception focus mainly on short term methods (pills and injections) due to lack of interest and/or trained providers. There are more midwife lead abortion providing facilities in Accra (40) than in Kumasi (10). Where midwives provided abortion services, contraceptives were readily available and clients encouraged to take a method following abortion. This practice was very common in NGO facilities as post abortion contraception was reported to be a mandatory package. Conclusions: The Ghanaian abortion law allows conditional abortion and not on demand. However, increasing numbers of abortions in the study area coupled with reported target setting for abortion services suggest abortion on demand and its being used as a family planning option. A nationwide facility based assessment of abortion and contraception service delivery is recommended to inform policy.

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Gender Intentional Approaches to Enhance Health Social Enterprises in Africa: A Qualitative Study of Constraints and Strategies

10.21203/rs.3.rs-69354/v2 ◽

2021 ◽

Author(s):

Kevin McKague ◽

Sarah Harrison ◽

Jenipher Musoke

Keyword(s):

Focus Group ◽

Health Outcomes ◽

Community Health ◽

Gender Equality ◽

Financial Incentives ◽

Social Enterprises ◽

Gender Integration ◽

Governmental Organizations ◽

Non Governmental Organizations ◽

Gender Based

Abstract Background: Health social enterprises are experimenting with community health worker (CHW) models that allow for various income-generating opportunities to motivate and incentivize CHWs. Although evidence shows that improving gender equality contributes to the achievement of health outcomes, gender-based constraints faced by CHWs working with social enterprises in Africa have not yet been empirically studied. This study is the first of its kind to address this important gap in knowledge. Methods: We conducted 36 key informant interviews and 21 focus group discussions between 2016 and 2019 (for a total of 175 individuals: 106 women and 69 men) with four health social enterprises in Uganda and Kenya and other related key stakeholders and domain experts. Interview and focus group transcripts were coded according to gender-based constraints and strategies for enhanced performance as well as key sites for intervention. Results: We found that CHW programs can be more gender responsive. We introduce the Gender Integration Continuum for Health Social Enterprises as a tool that can help guide gender equality efforts. Data revealed female CHWs face seven unique gender-based constraints (compared to male CHWs): 1) higher time burden and lack of economic empowerment; 2) risks to personal safety; 3) lack of career advancement and leadership opportunities; 4) lack of access to needed equipment, medicines and transport; 5) lack of access to capital; 6) lack of access to social support and networking opportunities; and 7) insufficient financial and non-financial incentives. Data also revealed four key areas of intervention: the health social enterprise, the CHW, the CHW’s partner, and the CHW’s patients. In each of the four areas, gender responsive strategies were identified to overcome constraints and contribute to improved gender equality and community health outcomes. Conclusions: This is the first study of its kind to identify the key gender-based constraints and gender responsive strategies for health social enterprises in Africa using CHWs. Findings can assist organizations working with CHWs in Africa (social enterprises, governments or non-governmental organizations) to develop gender responsive strategies that increase the gender and health outcomes while improving gender equality for CHWs, their families, and their communities.

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Gender intentional approaches to enhance health social enterprises in Africa: a qualitative study of constraints and strategies

International Journal for Equity in Health ◽

10.1186/s12939-021-01427-0 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Kevin McKague ◽

Sarah Harrison ◽

Jenipher Musoke

Keyword(s):

Focus Group ◽

Health Outcomes ◽

Community Health ◽

Gender Equality ◽

Financial Incentives ◽

Social Enterprises ◽

Gender Integration ◽

Governmental Organizations ◽

Non Governmental Organizations ◽

Gender Based

AbstractBackgroundHealth social enterprises are experimenting with community health worker (CHW) models that allow for various income-generating opportunities to motivate and incentivize CHWs. Although evidence shows that improving gender equality contributes to the achievement of health outcomes, gender-based constraints faced by CHWs working with social enterprises in Africa have not yet been empirically studied. This study is the first of its kind to address this important gap in knowledge.MethodsWe conducted 36 key informant interviews and 21 focus group discussions between 2016 and 2019 (for a total of 175 individuals: 106 women and 69 men) with four health social enterprises in Uganda and Kenya and other related key stakeholders and domain experts. Interview and focus group transcripts were coded according to gender-based constraints and strategies for enhanced performance as well as key sites for intervention.ResultsWe found that CHW programs can be more gender responsive. We introduce theGender Integration Continuum for Health Social Enterprisesas a tool that can help guide gender equality efforts. Data revealed female CHWs face seven unique gender-based constraints (compared to male CHWs): 1) higher time burden and lack of economic empowerment; 2) risks to personal safety; 3) lack of career advancement and leadership opportunities; 4) lack of access to needed equipment, medicines and transport; 5) lack of access to capital; 6) lack of access to social support and networking opportunities; and 7) insufficient financial and non-financial incentives. Data also revealed four key areas of intervention: 1) the health social enterprise; 2) the CHW; 3) the CHW’s partner; and 4) the CHW’s patients. In each of the four areas, gender responsive strategies were identified to overcome constraints and contribute to improved gender equality and community health outcomes.ConclusionsThis is the first study of its kind to identify the key gender-based constraints and gender responsive strategies for health social enterprises in Africa using CHWs. Findings can assist organizations working with CHWs in Africa (social enterprises, governments or non-governmental organizations) to develop gender responsive strategies that increase the gender and health outcomes while improving gender equality for CHWs, their families, and their communities.

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“… the way we welcome them is how we will lead them to love family planning.”: family planning providers in Rwanda foster compassionate relationships with clients despite workplace challenges

BMC Health Services Research ◽

10.1186/s12913-021-06282-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hilary M. Schwandt ◽

Angel Boulware ◽

Julia Corey ◽

Ana Herrera ◽

Ethan Hudler ◽

...

Keyword(s):

Data Analysis ◽

Family Planning ◽

Contraceptive Use ◽

Health Workers ◽

Government Support ◽

Modern Contraceptive ◽

Group Discussions ◽

Short Period ◽

Study Participants ◽

Depth Interviews

Abstract Background Rwanda has markedly increased the nation’s contraceptive use in a short period of time, tripling contraceptive prevalence in just 5 years between 2005 and 2010. An integral aspect of family planning programs is the interactions between family planning providers and clients. This study aims to understand the client-provider relationship in the Rwandan family planning program and to also examine barriers to those relationships. Methods This qualitative study in Rwanda utilized convenience sampling to include eight focus group discussions with family planning providers, both family planning nurses and community health workers, as well as in-depth interviews with 32 experienced modern contraceptive users. Study participants were drawn from the two districts in Rwanda with the highest and lowest modern contraceptive rates, Musanze and Nyamasheke, respectively Data analysis was guided by the thematic content approach, Atlas.ti 8 was utilized for coding the transcripts and collating the coding results, and Microsoft Excel for analyzing the data within code. Results Data analysis revealed that, despite workplace related challenges – including inadequate staffing, training, and resources, relationships between providers and clients are strong. Family planning providers work hard to understand, learn from, and support clients in their initiation and sustained use of contraceptives. Conclusion Given the existing context of purposeful efforts on the part of family planning providers to build relationships with their clients, if the current level of government support for family planning service provision is enhanced, Rwanda will likely sustain many current users of contraception and engage even more Rwandans in contraceptive services in the future.

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