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Using theory and formative research to design interventions to improve community health worker motivation, retention and performance in Mozambique and Uganda

Strachan, DL; Hill, Z; Källander, K; Nakirunda, M; Ndima, S; Muiambo, A; (2015) Using theory and formative research to design interventions to improve community health worker motivation, retention and performance in Mozambique and Uganda. Human Resources for Health , 13 (25) 10.1186/s12960-015-0020-8. Green open access

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Abstract

Background: Community health workers (CHWs) are increasingly being used in low-income countries to address human resources shortages, yet there remain few effective, evidence-based strategies for addressing the enduring programmatic constraints of worker motivation, retention and performance. This paper describes how two interventions were designed by the Innovations at Scale for Community Access and Lasting Effects (inSCALE) project to address these constraints in Uganda and Mozambique drawing on behavioural theory and formative research results. Methods: A review of the work motivation and CHW motivation literature-incorporating influences on retention and performance-was conducted on articles sourced through electronic web searches. Formative research with a focus on the barriers and facilitators to CHW motivation, retention and performance was conducted with community health workers and key stakeholders in Uganda and Mozambique. An analytical induction approach to the thematic analysis of transcripts from 98 in-depth interviews and 26 focus group discussions was adopted across the country settings. Results: From the theoretical review, it was determined that the interventions should promote CHWs as members of a collective by highlighting a sense of shared experience, focus on alignment between worker and programme goals, and emphasise the actions that lead to good performance. The Social Identity Approach was selected as the theory most likely to lead to the development of effective, scalable and sustainable interventions by addressing the identified gap in the literature of the influence of CHW working context. The formative research indicated that CHWs value feedback and feeling connected to the health system and their community, are motivated by status and community standing, and want to be provided with the necessary tools to perform. Two interventions based on these results were developed: a participatory, local community approach and an information communication technology (ICT) approach. Conclusions: Drawing on contextual data and theory that is sensitive to context can potentially lead to the development of appropriate and effective interventions when aiming to improve the motivation, retention and performance of CHWs in Uganda and Mozambique and other comparable settings. Evaluation of the developed interventions is crucial to assess this potential.

Type: Article
Title: Using theory and formative research to design interventions to improve community health worker motivation, retention and performance in Mozambique and Uganda
Open access status: An open access version is available from UCL Discovery
DOI: 10.1186/s12960-015-0020-8
Publisher version: http://dx.doi.org/10.1186/s12960-015-0020-8
Language: English
Additional information: Copyright © 2015 Strachan et al.; licensee BioMed Central. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article,unless otherwise stated.
Keywords: Community health workers, Motivation, Retention, Performance, Social Identity Approach, Human resources for health, Uganda, Mozambique.
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
URI: https://discovery.ucl.ac.uk/id/eprint/1469370
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