title: The female community health volunteer programme in Nepal: decision makers' perceptions of volunteerism, payment and other incentives.
abstract: The Female Community Health Volunteer (FCHV) Programme in Nepal has existed since the late 1980s and includes almost 50,000 volunteers. Although volunteer programmes are widely thought to be characterised by high attrition levels, the FCHV Programme loses fewer than 5% of its volunteers annually. The degree to which decision makers understand community health worker motivations and match these with appropriate incentives is likely to influence programme sustainability. The purpose of this study was to explore the views of stakeholders who have participated in the design and implementation of the Female Community Health Volunteer regarding Volunteer motivation and appropriate incentives, and to compare these views with the views and expectations of Volunteers. Semi-structured interviews were carried out in 2009 with 19 purposively selected non-Volunteer stakeholders, including policy makers and programme managers. Results were compared with data from previous studies of Female Community Health Volunteers and from interviews with four Volunteers and two Volunteer activists. Stakeholders saw Volunteers as motivated primarily by social respect, religious and moral duty. The freedom to deliver services at their leisure was seen as central to the volunteer concept. While stakeholders also saw the need for extrinsic incentives such as micro-credit, regular wages were regarded not only as financially unfeasible, but as a potential threat to the Volunteers' social respect, and thereby to their motivation. These views were reflected in interviews with and previous studies of Female Community Health Volunteers, and appear to be influenced by a tradition of volunteering as moral behaviour, a lack of respect for paid government workers, and the Programme's community embeddedness. Our study suggests that it may not be useful to promote a generic range of incentives, such as wages, to improve community health worker programme sustainability. Instead, programmes should ensure that the context-specific expectations of community health workers, programme managers, and policy makers are in alignment if low attrition and high performance are to be achieved.
authors.affiliation: Department of Global Health and Welfare, SINTEF Society and Technology, P.O. Box 124 Blindern, Oslo 0314, Norway. Electronic address: claire.glenton@sintef.no.
authors.forename: Claire
authors.initials: C
authors.lastname: Glenton
authors.affiliation: Department of Global Health and Welfare, SINTEF Society and Technology, P.O. Box 124 Blindern, Oslo 0314, Norway.
authors.forename: Inger B
authors.initials: IB
authors.lastname: Scheel
authors.affiliation: Nepal Family Health Program, Kathmandu, Nepal.
authors.forename: Sabina
authors.initials: S
authors.lastname: Pradhan
authors.affiliation: Norwegian Knowledge Centre for the Health Services, Norway; Medical Research Council of South Africa, Cape Town, South Africa.
authors.forename: Simon
authors.initials: S
authors.lastname: Lewin
authors.affiliation: Nepal Family Health Program, Kathmandu, Nepal.
authors.forename: Stephen
authors.initials: S
authors.lastname: Hodgins
authors.affiliation: Independent consultant, social scientist, Kathmandu, Nepal.
authors.forename: Vijaya
authors.initials: V
authors.lastname: Shrestha
mesh_terms: D003150:Community Health Workers / Q000191:economics / Q000458:organization & administration*; D003659:Decision Making, Organizational; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D009042:Motivation; D009390:Nepal; D015397:Program Evaluation; D036301:Qualitative Research; D012456:Salaries and Fringe Benefits; D014838:Volunteers / Q000458:organization & administration* / Q000523:psychology