Retention of community health workers through technology provision

Study into motivational drivers for community health worker retention in Tana River County, Kenya

About

Community Health Workers (CHWs) play an indispensable role in providing basic health services and addressing the health worker shortages in low-resource settings. Therefore, it is essential to keep CHWs motivated so that they remain committed to their function. Early evidence suggests that empowerment of CHWs through provision of equipment and tools improves staff retention. To validate this hypothesis, this project studied various motivation drivers, such as technology provision, in several Red Cross entities, and established the impact on staff retention.

Partners

How

We hypothesized that providing CHWs with the right tools to perform their roles, and providing them with skills to enable them to establish a stable livelihoods base, will prevent attrition and motivate them to remain in their employment. Through this study, we aimed to identify the main motivators and explored the use of two interventions in achieving the objectives:

Provision of a CHW Outreach Kit, containing basic diagnostic tools that support CHWs in their efforts to triage and diagnose at the community level, before referring clients to the next level health facilities.
A mentoring and career enhancement program, focusing on welfare needs and ways to establish a stable income/livelihood base, in order to reduce income-related attrition.

The study was embedded in an ongoing iCCM (Integrated Community Care Management) project run by the Red Cross in Tana River County, Kenya. A total of 63 CHWs participated in the study. A quasi-experimental design, utilizing qualitative and quantitative data collection methods, was used to explore the two types of motivation enhancements and compare them to a control group.

Results

The finalized study successfully contributes to the body of knowledge onCHW motivation and attrition factors. It demonstrated that providing tools and equipment such as an outreach kit as a one-off incentive can have a lasting effect on motivation, by increasing confidence in CHWs’ abilities to implement iCCM. This intervention also had a ripple effect on other factors known to motivate CHWs, such as training and skills development, recognition, community trust, and linkage to the health facility.

The study also demonstrated that both financial and non-financial incentives are important in the motivation and retention of CHWs.

Learnings and next steps

A desire and passion to assist the community, encouragement by community members, hope for career advancement, recognition in the community, and receiving a salary, stipend or token, were the main motivations to become a CHW.
Outreach kits ranked highly as a motivator across all study groups, and highest among other incentives for those who had received them. This was driven by the effects of the Outreach kits on capacity building, expansion of the role of CHWs, enhanced credibility and community trust, and enhanced flexibility in the work of CHWs.
Providing alternative skills that can be applied to generate income reduced the need for CHWs to leave the system to pursue revenue generating opportunities. The study found that mentorship on crop and livestock farming were selected most by CHWs from the range of skill enhancement opportunities offered.

The study has now been concluded and results disseminated with Red Cross entities county stakeholders involved in it. Philips Foundation endorses the positive results of empowering community health workers with tools, technologies, and skills that enable them to perform more advanced tasks, boost their motivation and increase their capacity to help bridge existing health gaps.