Impact of a recognition package as an incentive to strengthen the motivation, performance, and retention of village health teams in Uganda: A study protocol for a cluster randomized controlled trial

Abstract

Abstract Introduction: Uganda’s community health worker (CHW), or village health team (VHT), program faces significant challenges with poor retention and insufficient financial and program investment. Adequate compensation comprising of financial and non-financial components is critical to retaining any workforce, including CHWs. This study evaluates the impact of a recognition-based non-financial incentives package on the motivation, performance, and retention of VHTs, as well as on the utilization of health services by the community. The incentives package and intervention were developed in collaboration with the District-level leadership and awards VHTs who have met predetermined performance thresholds with a certificate and a government branded jacket in a public ceremony. Methods: A two-armed cluster randomized controlled trial (RCT), conducted at the parish-level in Uganda’s Masindi District, will evaluate the effects of the 12-month intervention. The cluster-RCT will use a mixed-methods approach, which includes a baseline/endline VHT survey to assess impact of intervention on key outcomes, with a sample of 304 VHTs per study arm; VHT performance data will be validated using monthly phone surveys tracking key performance indicators and through abstraction of VHT-submitted health facility data; VHT retention will be tracked through a VHT listing activity; and focus group discussions will be conducted with VHTs and community members to understand how intervention was received. Data collection activities will be administered in local languages. A linear regression analysis (adjusting for cluster-effect) and a difference-in-differences analysis will be utilized to assess impact of the intervention. Discussion: This study utilized a cluster-RCT design to assess the impact of a recognition-based incentives intervention on the motivation, performance, and retention of VHTs in Uganda’s Masindi District. Utilizing a mixed-methods approach, the study will provide insights on the effectiveness and limitations of the intervention, VHT perspectives on perceived value, and critical insights on how non-financial incentives might support the strengthening of the community health workforce. Trial Registration: This trial was retrospectively registered on ClinicalTrials.gov (Registration Number: NCT05176106) on January 4, 2022.