Abstract
BackgroundCommunity health workers (CHWs) play a critical role in supporting health systems, and in improving accessibility to primary healthcare. In many settings CHW programmes do not have formalised employment models and face issues of high attrition and poor performance. This study aims to determine the employment preferences of CHWs in Malang district, Indonesia, to inform policy interventions.MethodsA discrete choice experiment was conducted with 471 CHWs across 28 villages. Attributes relevant to CHW employment were identified through a multistage process including literature review, focus group discussions and expert consultation. Respondents’ choices were analysed with a mixed multinomial logit model and latent class analyses.ResultsFive attributes were identified: (1) supervision; (2) training; (3) monthly financial benefit; (4) recognition; and (5) employment structure. The most important influence on choice of job was a low monthly financial benefit (US$~2) (β=0.53, 95% CI=0.43 to 0.63), followed by recognition in the form of a performance feedback report (β=0.13, 95% CI=0.07 to 0.20). A large monthly financial benefit (US$~20) was most unappealing to respondents (β=−0.13, 95% CI=−0.23 to −0.03). Latent class analysis identified two groups of CHWs who differed in their willingness to accept either job presented and preferences over specific attributes. Preferences diverged based on respondent characteristics including experience, hours’ worked per week and income.ConclusionCHWs in Malang district, Indonesia, favour a small monthly financial benefit which likely reflects the unique cultural values underpinning the programme and a desire for remuneration that is commensurate with the limited number of hours worked. CHWs also desire enhanced methods of performance feedback and greater structure around training and their rights and responsibilities. Fulfilling these conditions may become increasingly important should CHWs work longer hours.
Funder
National Health and Medical Research Council
Subject
Public Health, Environmental and Occupational Health,Health Policy
Reference44 articles.
1. Community health workers for universal health-care coverage: from fragmentation to synergy
2. Lehmann U , Sanders D . Community health workers: what do we know about them? The state of the evidence on programmes, activities, costs an impact on health outcomes of using community health workers. Geneva: World Health Organization, 2007.
3. Perry H , Zulliger R , Scott K . Case studies of large-scale community health worker programs: examples from Afghanistan, Bangladesh, Brazil, Ethiopia, Niger, India, Indonesia, Iran, Nepal, Pakistan, Rwanda, Zambia, and Zimbabwe. USAID, 2017.
4. The effect of payment and incentives on motivation and focus of community health workers: five case studies from low- and middle-income countries
5. Can lay health workers increase the uptake of childhood immunisation? Systematic review and typology;Glenton;Trop Med Int Health,2011
Cited by
5 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献