title: Motivation and satisfaction among community health workers in Morogoro Region, Tanzania: nuanced needs and varied ambitions.
abstract: BACKGROUND
  In 2012, the Ministry of Health and Social Welfare (MOHSW), Tanzania, approved national guidelines and training materials for community health workers (CHWs) in integrated maternal, newborn and child health (Integrated MNCH), with CHWs trained and deployed across five districts of Morogoro Region soon after. To inform future scale up, this study assessed motivation and satisfaction among these CHWs.
  
  
  METHODS
  A survey of all CHWs trained by the Integrated MNCH Programme was conducted in the last quarter of 2013. Motivation and satisfaction were assessed using a five-point Likert scale with 29 and 27 items based on a literature review and discussions with CHW programme stakeholders. Exploratory factor analysis was conducted to identify motivation and satisfaction determinants.
  
  
  RESULTS
  Out of 238 eligible CHWs, 96 % were included in the study. Findings showed that respondents were motivated to become CHWs due to altruism (work on MNCH, desire to serve God, work hard) and intrinsic needs (help community, improve health, pride) than due to external stimuli (monetary incentives, skill utilization, community respect or hope for employment). CHWs were satisfied by relationships with health workers and communities, job aids and the capacity to provide services. CHWs were dissatisfied with the lack of transportation, communication devices and financial incentives for carrying out their tasks. Factors influencing motivation and satisfaction did not differ across CHW socio-demographic characteristics. Nonetheless, older and less educated CHWs were more likely to be motivated by altruism, intrinsic needs and skill utilization, community respect and hope for employment. Less educated CHWs were more satisfied with service and quality factors and more wealthy CHWs satisfied with job aids.
  
  
  CONCLUSIONS
  A combination of financial and non-financial incentives is required to support motivation and satisfaction among CHWs. Although CHWs joined mainly due to their altruistic nature, they became discontented with the lack of monetary compensation, transportation and communication support received. With the planned rollout of the national CHW cadre, improved understanding of CHWs as a heterogeneous group with nuanced needs and varied ambitions is vital for ensuring sustainability.
authors.affiliation: Muhimbili University of Health and Allied Sciences, School of Public Health and Social Sciences, P.O. Box 65015, Dar-es-Salaam, Tanzania. rcmpembeni@yahoo.com.
authors.forename: Rose N M
authors.initials: RN
authors.lastname: Mpembeni
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA. abhatna4@jhmi.edu.
authors.forename: Aarushi
authors.initials: A
authors.lastname: Bhatnagar
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA. aelefevre@jhu.edu.
authors.forename: Amnesty
authors.initials: A
authors.lastname: LeFevre
authors.affiliation: Muhimbili University of Health and Allied Sciences, School of Public Health and Social Sciences, P.O. Box 65015, Dar-es-Salaam, Tanzania. dereck.chitama@gmail.com.
authors.forename: Dereck
authors.initials: D
authors.lastname: Chitama
authors.affiliation: Muhimbili University of Health and Allied Sciences, School of Public Health and Social Sciences, P.O. Box 65015, Dar-es-Salaam, Tanzania. durassa2@yahoo.co.uk.
authors.forename: David P
authors.initials: DP
authors.lastname: Urassa
authors.affiliation: Muhimbili University of Health and Allied Sciences, School of Public Health and Social Sciences, P.O. Box 65015, Dar-es-Salaam, Tanzania. Kilewo1950@gmail.com.
authors.forename: Charles
authors.initials: C
authors.lastname: Kilewo
authors.affiliation: Jhpiego, Bagamoyo Road, Victoria Area, P.O. Box 9170, Dar es Salaam, Tanzania. Rebecca.Mdee@jhpiego.org.
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Mdee
authors.affiliation: Tanzania Ministry of Health and Social Welfare, Health Promotion Section, 6 Samora Machel Avenue, 11478, Dar es Salaam, Tanzania. hi.semu@gmail.com.
authors.forename: Helen
authors.initials: H
authors.lastname: Semu
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA. pwinch@jhu.edu.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Winch
authors.affiliation: Muhimbili University of Health and Allied Sciences, School of Public Health and Social Sciences, P.O. Box 65015, Dar-es-Salaam, Tanzania. jkillewo@yahoo.co.uk.
authors.forename: Japhet
authors.initials: J
authors.lastname: Killewo
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA. abaqui@jhu.edu.
authors.forename: Abdullah H
authors.initials: AH
authors.lastname: Baqui
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA. ageorg22@jhu.edu.
authors.forename: Asha
authors.initials: A
authors.lastname: George
mesh_terms: D000328:Adult; D000367:Age Factors; D000533:Altruism; D001291:Attitude of Health Personnel; D002321:Career Choice; D003150:Community Health Workers; D004522:Educational Status; D005260:Female; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010549:Personal Satisfaction; D012111:Residence Characteristics; D012456:Salaries and Fringe Benefits; D013636:Tanzania