Factors affecting recruitment and retention of community health workers in a newborn care intervention in Bangladesh.
BACKGROUND
Well-trained and highly motivated community health workers (CHWs) are critical for delivery of many community-based newborn care interventions. High rates of CHW attrition undermine programme effectiveness and potential for implementation at scale. We investigated reasons for high rates of CHW attrition in Sylhet District in north-eastern Bangladesh.


METHODS
Sixty-nine semi-structured questionnaires were administered to CHWs currently working with the project, as well as to those who had left. Process documentation was also carried out to identify project strengths and weaknesses, which included in-depth interviews, focus group discussions, review of project records (i.e. recruitment and resignation), and informal discussion with key project personnel.


RESULTS
Motivation for becoming a CHW appeared to stem primarily from the desire for self-development, to improve community health, and for utilization of free time. The most common factors cited for continuing as a CHW were financial incentive, feeling needed by the community, and the value of the CHW position in securing future career advancement. Factors contributing to attrition included heavy workload, night visits, working outside of one's home area, familial opposition and dissatisfaction with pay.


CONCLUSIONS
The framework presented illustrates the decision making process women go through when deciding to become, or continue as, a CHW. Factors such as job satisfaction, community valuation of CHW work, and fulfilment of pre-hire expectations all need to be addressed systematically by programs to reduce rates of CHW attrition.
Rahman
Syed Moshfiqur
SM
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland USA. pwinch@jhsph.edu.
Ali
Nabeel Ashraf
NA
Jennings
Larissa
L
Seraji
M Habibur R
MH
Mannan
Ishtiaq
I
Shah
Rasheduzzaman
R
Al-Mahmud
Arif Billah
AB
Bari
Sanwarul
S
Hossain
Daniel
D
Das
Milan Krishna
MK
Baqui
Abdullah H
AH
El Arifeen
Shams
S
Winch
Peter J
PJ