title: Inspiring health worker motivation with supportive supervision: a survey of lady health supervisor motivating factors in rural Pakistan.
abstract: Community health worker motivation is an important consideration for improving performance and addressing maternal, newborn, and child health in low and middle-income countries. Therefore, identifying health system interventions that address motivating factors in resource-strained settings is essential. This study is part of a larger implementation research project called Nigraan, which is intervening on supportive supervision in the Lady Health Worker Programme to improve community case management of pneumonia and diarrhea in rural Pakistan. This study explored the motivation of Lady Health Supervisors, a cadre of community health workers, with particular attention to their views on supportive supervision.
  
  
  
  Twenty-nine lady health supervisors enrolled in Nigraan completed open-ended structured surveys with questions exploring factors that affect their motivation. Thematic analysis was conducted using a conceptual framework categorizing motivating factors at individual, community, and health system levels.
  
  
  
  Supportive supervision, recognition, training, logistics, and salaries are community and health system motivating factors for lady health supervisors. Lady health supervisors are motivated by both their role in providing supportive supervision to lady health workers and by the supervisory support received from their coordinators and managers. Family support, autonomy, and altruism are individual level motivating factors.
  
  
  
  Health system factors, including supportive supervision, are crucial to improving lady health supervisor motivation. As health worker motivation influences their performance, evaluating the impact of health system interventions on community health worker motivation is important to improving the effectiveness of community health worker programs.
authors.affiliation: Department of Community Health Sciences, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74 800, Pakistan. fauziah.rabbani@aku.edu.
authors.forename: Fauziah
authors.initials: F
authors.lastname: Rabbani
authors.affiliation: Department of Community Health Sciences, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74 800, Pakistan.
authors.forename: Leah
authors.identifier: 0000-0002-6105-4091
authors.initials: L
authors.lastname: Shipton
authors.affiliation: Department of Community Health Sciences, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74 800, Pakistan.
authors.forename: Wafa
authors.initials: W
authors.lastname: Aftab
authors.affiliation: Department of Community Health Sciences, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74 800, Pakistan.
authors.forename: Kashif
authors.initials: K
authors.lastname: Sangrasi
authors.affiliation: Department of Community Health Sciences, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74 800, Pakistan.
authors.forename: Shagufta
authors.initials: S
authors.lastname: Perveen
authors.affiliation: Department of Community Health Sciences, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74 800, Pakistan.
authors.forename: Aysha
authors.initials: A
authors.lastname: Zahidie
mesh_terms: D001291:Attitude of Health Personnel; D019090:Case Management; D002648:Child; D003150:Community Health Workers / Q000193:education / Q000458:organization & administration / Q000523:psychology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000458:organization & administration; D006801:Humans; D007231:Infant, Newborn; D009042:Motivation; D010154:Pakistan; D017009:Professional Autonomy; D012111:Residence Characteristics; D012423:Rural Health; D012456:Salaries and Fringe Benefits; D012944:Social Support; D011795:Surveys and Questionnaires
keywords: Community health worker; Health system; Implementation research; Lady health supervisor; Lady health worker; Motivation; Pakistan; Supportive supervision