title: Motivation of Community Health Workers in Diagnosing, Treating, and Referring Sick Young Children in a Multicountry Study.
abstract: BACKGROUND
  Community health workers (CHWs) are an important element of care provision for a wide range of conditions, but their turnover rate is high. Many studies have been conducted on health workers' motivation, focusing on formal sector staff but not CHWs. Although CHWs are easy to recruit, motivating and retaining them for service delivery is difficult. This article investigates factors influencing CHW motivation and retention in health service delivery.
  
  
  METHODS
  Quantitative and qualitative data were collected to identify the key factors favoring motivation and retention of CHWs as well as those deterring them. We interviewed 47, 25, and 134 CHWs in Burkina Faso, Nigeria, and Uganda, respectively, using a structured questionnaire. Focus group discussions (FGDs) were also conducted with CHWs, community participants, and facility health workers.
  
  
  RESULTS
  Except for Burkina Faso, most CHWs were female. Average age was between 38 and 41 years, and most came from agricultural communities. The majority (52%-80%) judged they had a high to very high level of satisfaction, but most CHWs (approximately 75%) in Burkina Faso and Uganda indicated that they would be prepared to leave the job, citing income as a major reason. Community recognition and opportunities for training and supervision were major incentives in all countries, but the volume of unremunerated work, at a time when both malaria-positive cases and farming needs were at their peak, was challenging.
  
  
  CONCLUSIONS
  Most CHWs understood the volunteer nature of their position but desired community recognition and modest financial remuneration.
  
  
  BACKGROUND
  ISRCTN13858170.
authors.affiliation: Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso.
authors.forename: Armande K
authors.initials: AK
authors.lastname: Sanou
authors.affiliation: Department of Sociology, Faculty of the Social Sciences.
authors.forename: Ayodele S
authors.initials: AS
authors.lastname: Jegede
authors.affiliation: Child Health Division, Ministry of Health, Kampala, Uganda.
authors.forename: Jesca
authors.initials: J
authors.lastname: Nsungwa-Sabiiti
authors.affiliation: Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso.
authors.forename: Mohamadou
authors.initials: M
authors.lastname: Siribié
authors.affiliation: Department of Epidemiology and Medical Statistics.
authors.forename: IkeOluwapo O
authors.initials: IO
authors.lastname: Ajayi
authors.affiliation: Child Health Division, Ministry of Health, Kampala, Uganda.
authors.forename: Asaf
authors.initials: A
authors.lastname: Turinde
authors.affiliation: Department of Health Promotion and Education, Faculty of Public Health.
authors.forename: Frederick O
authors.initials: FO
authors.lastname: Oshiname
authors.affiliation: Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso.
authors.forename: Luc
authors.initials: L
authors.lastname: Sermé
authors.affiliation: Child Health Division, Ministry of Health, Kampala, Uganda.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Kabarungi
authors.affiliation: Department of Pharmacology and Therapeutics.
authors.forename: Catherine O
authors.initials: CO
authors.lastname: Falade
authors.affiliation: Child Health Division, Ministry of Health, Kampala, Uganda.
authors.forename: Josephine
authors.initials: J
authors.lastname: Kyaligonza
authors.affiliation: Epidemiology and Biostatistics Research Unit, Institute of Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria.
authors.forename: Chinenye
authors.initials: C
authors.lastname: Afonne
authors.affiliation: Child Health Division, Ministry of Health, Kampala, Uganda.
authors.forename: Andrew
authors.initials: A
authors.lastname: Balyeku
authors.affiliation: Department of Health Services Research, School for Public Health and Primary Care, Maastricht University, The Netherlands.
authors.forename: Joëlle
authors.initials: J
authors.lastname: Castellani
authors.affiliation: UNICEF/UNDP/World Bank/WHO/Special Programme for Research & Training in Tropical Diseases, World Health Organization, Geneva, Switzerland.
authors.forename: Melba
authors.initials: M
authors.lastname: Gomes
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002050:Burkina Faso; D003150:Community Health Workers / Q000523:psychology* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009549:Nigeria; D014454:Uganda; D014838:Volunteers / Q000706:statistics & numerical data
keywords: Africa; community health worker; motivation; retention; volunteers