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.
Conclusion and recommendations: 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.
