Using a human resource management approach to support community health workers: experiences from five African countries.
BACKGROUND
Like any other health worker, community health workers (CHWs) need to be supported to ensure that they are able to contribute effectively to health programmes. Management challenges, similar to those of managing any other health worker, relate to improving attraction, retention and performance.


METHODS
Exploratory case studies of CHW programmes in the Democratic Republic of Congo, Ghana, Senegal, Uganda and Zimbabwe were conducted to provide an understanding of the practices for supporting and managing CHWs from a multi-actor perspective. Document reviews (n = 43), in-depth interviews with programme managers, supervisors and community members involved in managing CHWs (n = 31) and focus group discussions with CHWs (n = 13) were conducted across the five countries. Data were transcribed, translated and analysed using the framework approach.


RESULTS
CHWs had many expectations of their role in healthcare, including serving the community, enhancing skills, receiving financial benefits and their role as a CHW fitting in with their other responsibilities. Many human resource management (HRM) practices are employed, but how well they are implemented, the degree to which they meet the expectations of the CHWs and their effects on human resource (HR) outcomes vary across contexts. Front-line supervisors, such as health centre nurses and senior CHWs, play a major role in the management of CHWs and are central to the implementation of HRM practices. On the other hand, community members and programme managers have little involvement with managing the CHWs.


CONCLUSIONS
This study highlighted that CHW expectations are not always met through HRM practices. This paper calls for a coordinated HRM approach to support CHWs, whereby HRM practices are designed to not only address expectations but also ensure that the CHW programme meets its goals. There is a need to work with all three groups of management actors (front-line supervisors, programme managers and community members) to ensure the use of an effective HRM approach. A larger multi-country study is needed to test an HRM approach that integrates context-appropriate strategies and coordinates relevant management actors. Ensuring that CHWs are adequately supported is vital if CHWs are to fulfil the critical role that they can play in improving the health of their communities.
Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK. Joanna.raven@lstmed.ac.uk.
Joanna
J
Raven
School of Public Health, University of Ghana, Accra, Ghana. akweongo@gmail.com.
Patricia
P
Akweongo
Institut Panafricain de Sante Communautaire, Bunia, Democratic Republic of Congo. amuda2b@yahoo.com.
Amuda
A
Baba
School of Public Health, Makerere University, Kampala, Uganda. sbaine@musph.ac.ug.
Sebastian Olikira
SO
Baine
Department of Paediatrics, University of Dakar, Dakar, Senegal. mgsall50@yahoo.fr.
Mohamadou Guelaye
MG
Sall
Biomedical Research and Training Institute, Harare, Zimbabwe. sbuzuzi@gmail.com.
Stephen
S
Buzuzi
Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK. Tim.martineau@lstmed.ac.uk.
Tim
T
Martineau
D017954:Africa South of the Sahara; D002983:Clinical Competence; D003150:Community Health Workers / Q000191:economics / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007318:Inservice Training; D007407:Interviews as Topic; D008297:Male; D009042:Motivation; D019982:Organizational Case Studies; D017063:Outcome Assessment, Health Care; D010560:Personnel Selection / Q000458:organization & administration*; D024382:Professional Role; D036301:Qualitative Research