CoChat
Sign Up
Cited by 35Global Health Workforce IssuesHealth Policy Implementation ScienceGlobal Maternal and Child Health

The DOI matches its Crossref record; 1 of the 1 references it cites were found in a registry or an index.

Improving the performance of community health workers in Swaziland: findings from a qualitative study

Open access
Geldsetzer, Pascal, De Neve, Jan-Walter, Boudreaux, Chantelle, Bärnighausen, Till, Bossert, Thomas J.·2017·Human Resources for Health
DOI 10.1186/s12960-017-0236-xPMC PMC5604406
Open this paper in CoChat — free accountOpen PDF

Abstract

BACKGROUND: The performance of community health workers (CHWs) in Swaziland has not yet been studied despite the existence of a large national CHW program in the country. This qualitative formative research study aimed to inform the design of future interventions intended to increase the performance of CHW programs in Swaziland. Specifically, focusing on four CHW programs, we aimed to determine what potential changes to their program CHWs and CHW program managers perceive as likely leading to improved performance of the CHW cadre. METHODS: The CHW cadres studied were the rural health motivators, mothers-to-mothers (M2M) mentors, HIV expert clients, and a community outreach team for HIV. We conducted semi-structured, face-to-face qualitative interviews with all (15) CHW program managers and a purposive sample of 54 CHWs. Interview transcripts were analyzed using conventional content analysis to identify categories of changes to the program that participants perceived would result in improved CHW performance. RESULTS: Across the four cadres, participants perceived the following four changes to likely lead to improved CHW performance: (i) increased monetary compensation of CHWs, (ii) a more reliable supply of equipment and consumables, (iii) additional training, and (iv) an expansion of CHW responsibilities to cover a wider array of the community's healthcare needs. The supervision of CHWs and opportunities for career progression were rarely viewed as requiring improvement to increase CHW performance. CONCLUSIONS: While this study is unable to provide evidence on whether the suggested changes would indeed lead to improved CHW performance, these views should nonetheless inform program reforms in Swaziland because CHWs and CHW program managers are familiar with the day-to-day operations of the program and the needs of the target population. In addition, program reforms that agree with their views would likely experience a higher degree of buy-in from these frontline health workers.

Overview

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1186/s12960-017-0236-x

Cites

1 of 1 references verified0 citation errors · 0 not checkable

Statistics

Verification

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • La motivation financière, aussi insuffisante, est un levier considérable afin de maintenir leur engagement aux services fournis.

    “La motivation financière, aussi insuffisante, est un levier considérable afin de maintenir leur engagement aux services fournis (Geldsetzer et al., 2017).”

    From Agents de Santé Communautaires (ASC) à la guérison du paludisme : Nouvelles stratégies d’élimination du paludisme (2026) · cites this paper as Geldsetzer et al., 2017

    The Results (Monetary compensation; page not available) report that pay was generally considered insufficient and that CHWs felt increased pay would improve their motivation and performance. But the Results (Expansion of CHWs’ responsibilities; page not available) identify helping the community—not financial compensation—as the main reason they continued working despite low pay. The claim’s emphasis on financial motivation as a means of maintaining engagement therefore goes beyond the finding. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • Les résultats de notre étude s'alignent aux résultats d'une étude de Geldsetzer et al., qui montrent que la motivation des ASC reste un élément déterminant pour leur engagement et leur performance.

    “Les résultats de notre étude s'alignent aux résultats d'une étude de Geldsetzer et al., qui montrent que la motivation des ASC reste un élément déterminant pour leur engagement et leur performance.”

    From Agents de Santé Communautaires (ASC) à la guérison du paludisme : Nouvelles stratégies d’élimination du paludisme (2026) · cites this paper as Geldsetzer et al., 2017

  • Le rapport du MSPLS stipule que les ASC ne sont pas supervisés de manière appropriée.

    “Le rapport du MSPLS stipule que les ASC ne sont pas supervisés de manière appropriée (Geldsetzer et al., 2017;MSPLS, 2015).”

    From Agents de Santé Communautaires (ASC) à la guérison du paludisme : Nouvelles stratégies d’élimination du paludisme (2026) · cites this paper as Geldsetzer et al., 2017

    The cited paper’s Discussion and Conclusions concern community health workers in Swaziland; they do not identify an MSPLS report or state that it found workers inadequately supervised. The paper says supervision was rarely mentioned as needing improvement, but that does not establish whether supervision was appropriate. I searched for the MSPLS report and inadequate supervision in our copy. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Citations

Cites

Flagged first, then by citations

Research works printed but not linked: 64

  1. World Health Organization. World health statistics 2015. Geneva: World Health Organization; 2015.
  2. World Health Organization: The World Health Report 2006—working together for health. 2006.
  3. World Health Organization, PEPFAR, UNAIDS. Task shifting—global recommendations and guidelines. Geneva: World Health Organization; 2008.
  4. World Health Organization. Optimizing health worker roles to improve access to key maternal and newborn health interventions through task shifting. Geneva: World Health Organization; 2012.
  5. East Central and Southern African Health Community. Task shifting in Swaziland: a case study. Washington, DC: Futures Group, Health Policy Initiative, Task Order 1; 2010.
  6. ICAP-Swaziland. RHM Review 2012. Mbabane: Columbia University; 2012.
  7. Palmas W, March D, Darakjy S, Findley SE, Teresi J, Carrasquillo O, Luchsinger JA. Community health worker interventions to improve glycemic control in people with diabetes: a systematic review and meta-analysis. J Gen Intern Med. 2015;30:1004–12. · DOI · Paper page
  8. Global Health Workforce Alliance, World Health Organization. Global experience of community health workers for delivery of health related Millenium Development Goals: a systematic review, country case studies, and recommendations for scaling up, vol. 2017. Geneva: World Health Organization; 2010.
  9. Lassi ZS, Bhutta ZA. Community-based intervention packages for reducing maternal and neonatal morbidity and mortality and improving neonatal outcomes. Cochrane Database Syst Rev. 2015;3:CD007754.
  10. Lewin S, Munabi-Babigumira S, Glenton C, Daniels K, Bosch-Capblanch X, van Wyk BE, Odgaard-Jensen J, Johansen M, Aja GN, Zwarenstein M, Scheel IB. Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases. Cochrane Database Syst Rev. 2010;3:CD004015. · DOI
  11. Naimoli J, Frymus D, Quain E, Roseman E. Community and formal health system support for enhanced community health worker performance: a U.S. government evidence summit. Washington, DC: United States Agency for International Development (USAID); 2012.
  12. Kok MC, Dieleman M, Taegtmeyer M, Broerse JE, Kane SS, Ormel H, Tijm MM, de Koning KA. Which intervention design factors influence performance of community health workers in low- and middle-income countries? A systematic review. Health Policy Plan. 2014;9:1207–27.
  13. Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15:1277–88. · DOI · Paper page
  14. Naimoli JF, Frymus DE, Wuliji T, Franco LM, Newsome MH. A community health worker "logic model": towards a theory of enhanced performance in low- and middle-income countries. Hum Resour Health. 2014;12:56. · DOI
  15. Palazuelos D, Ellis K, Im DD, Peckarsky M, Schwarz D, Farmer DB, Dhillon R, Johnson A, Orihuela C, Hackett J, et al. 5-SPICE: the application of an original framework for community health worker program design, quality improvement and research agenda setting. Glob Health Action. 2013;6:19658. · DOI
  16. Franco LM, Bennett S, Kanfer R. Health sector reform and public sector health worker motivation: a conceptual framework. Soc Sci Med. 2002;54:1255–66. · DOI
  17. Vroom V. Work motivation. New York: Wiley; 1964.
  18. Lawrence PR, Nohria N. Driven: how human nature shapes our choices. San Francisco: Jossey-Bass; 2002.
  19. Nohria N, Groysberg B, Lee L-E. Employee motivation: a powerful new model. Harv Bus Rev. 2008;86:78–84.
  20. Agyepong IA, Anafi P, Asiamah E, Ansah EK, Ashon DA, Narh-Dometey C. Health worker (internal customer) satisfaction and motivation in the public sector in Ghana. Int J Health Plann Manag. 2004;19:319–36. · DOI
  21. Chandler CI, Chonya S, Mtei F, Reyburn H, Whitty CJ. Motivation, money and respect: a mixed-method study of Tanzanian non-physician clinicians. Soc Sci Med. 2009;68:2078–88. · DOI
  22. Mathauer I, Imhoff I. Health worker motivation in Africa: the role of non-financial incentives and human resource management tools. Hum Resour Health. 2006;4:24. · DOI
  23. Behdjat H, Rifkin SB, Tarin E, Sheikh MR. A new role for women health volunteers in urban Islamic Republic of Iran. East Mediterr Health J. 2009;15:1164–73. · DOI
  24. Callaghan-Koru JA, Hyder AA, George A, Gilroy KE, Nsona H, Mtimuni A, Bryce J. Health workers' and managers’ perceptions of the integrated community case management program for childhood illness in Malawi: the importance of expanding access to child health services. Am J Trop Med Hyg. 2012;87:61–8. · DOI
  25. Dil Y, Strachan D, Cairncross S, Korkor AS, Hill Z. Motivations and challenges of community-based surveillance volunteers in the northern region of Ghana. J Community Health. 2012;37:1192–8. · DOI
  26. Elmardi KA, Malik EM, Abdelgadir T, Ali SH, Elsyed AH, Mudather MA, Elhassan AH, Adam I. Feasibility and acceptability of home-based management of malaria strategy adapted to Sudan's conditions using artemisinin-based combination therapy and rapid diagnostic test. Malar J. 2009;8:39. · DOI · Paper page
  27. Furth R, Crigler L. Improving CHW program functionality, performance and engagement: operations research results from Zambia. Washington, DC: USAID; 2012.
  28. Gusdal AK, Obua C, Andualem T, Wahlstrom R, Chalker J, Fochsen G. Peer counselors' role in supporting patients' adherence to ART in Ethiopia and Uganda. AIDS Care. 2011;23:657–62. · DOI
  29. Jack BA, Kirton JA, Birakurataki J, Merriman A. The personal value of being a palliative care community volunteer worker in Uganda: a qualitative study. Palliat Med. 2012;26:753–9. · DOI
  30. Javanparast S, Baum F, Labonte R, Sanders D. Community health workers' perspectives on their contribution to rural health and well-being in Iran. Am J Public Health. 2011;101:2287–92. · DOI
  31. Mukherjee JS, Eustache FE. Community health workers as a cornerstone for integrating HIV and primary healthcare. AIDS Care. 2007;19(Suppl 1):S73–82. · DOI
  32. Nyanzi S, Manneh H, Walraven G. Traditional birth attendants in rural Gambia: beyond health to social cohesion. Afr J Reprod Health. 2007;11:43–56. · DOI
  33. Rahman SM, Ali NA, Jennings L, Seraji MH, Mannan I, Shah R, Al-Mahmud AB, Bari S, Hossain D, Das MK, et al. Factors affecting recruitment and retention of community health workers in a newborn care intervention in Bangladesh. Hum Resour Health. 2010;8:12. · DOI
  34. Root R, van Wyngaard A. Free love: a case study of church-run home-based caregivers in a high vulnerability setting. Glob Public Health. 2011;6(Suppl 2):S174–91. · DOI
  35. Rowe SY, Kelly JM, Olewe MA, Kleinbaum DG, McGowan JE Jr, McFarland DA, Rochat R, Deming MS. Effect of multiple interventions on community health workers' adherence to clinical guidelines in Siaya district, Kenya. Trans R Soc Trop Med Hyg. 2007;101:188–202. · DOI
  36. Sanjana P, Torpey K, Schwarzwalder A, Simumba C, Kasonde P, Nyirenda L, Kapanda P, Kakungu-Simpungwe M, Kabaso M, Thompson C. Task-shifting HIV counselling and testing services in Zambia: the role of lay counsellors. Hum Resour Health. 2009;7:44. · DOI
  37. Schneider H, Hlophe H, van Rensburg D. Community health workers and the response to HIV/AIDS in South Africa: tensions and prospects. Health Policy Plan. 2008;23:179–87. · DOI
  38. Simba DO, Kakoko DC. Volunteerism among out-of-school adolescent reproductive health peer educators: is it a sustainable strategy in resource constrained countries? Afr J Reprod Health. 2009;13:99–110.
  39. Simwaka BN, Theobald S, Willets A, Salaniponi FM, Nkhonjera P, Bello G, Squire SB. Acceptability and effectiveness of the storekeeper-based TB referral system for TB suspects in sub-districts of Lilongwe in Malawi. PLoS One. 2012;7:e39746. · DOI
  40. Srivastava DK, Prakash S, Adhish V, Nair KS, Gupta S, Nandan D. A study of interface of ASHA with the community and the service providers in Eastern Uttar Pradesh. Indian J Public Health. 2009;53:133–6.
  41. Takasugi T, Lee AC. Why do community health workers volunteer? A qualitative study in Kenya. Public Health. 2012;126:839–45. · DOI
  42. Lee MT, Raschke RL. Understanding employee motivation and organizational performance: Arguments for a set-theoretic approach. J Innov Knowl. 2016;1:162–9. · DOI
  43. Kok MC, Kane SS, Tulloch O, Ormel H, Theobald S, Dieleman M, Taegtmeyer M, Broerse JE, de Koning KA. How does context influence performance of community health workers in low- and middle-income countries? Evidence from the literature. Health Res Policy Syst. 2015;13:13. · DOI
  44. Lee MH, Kim HC, Thomas GN, Ahn SV, Hur NW, Choi DP, Suh I. Familial concordance of metabolic syndrome in Korean population—Korean National Health and Nutrition Examination Survey 2005. Diabetes Res Clin Pract. 2011;93:430–6. · DOI
  45. Park HS, Park JY, Cho SI. Familial aggregation of the metabolic syndrome in Korean families with adolescents. Atherosclerosis. 2006;186:215–21. · DOI
  46. Hippisley-Cox J, Coupland C, Pringle M, Crown N, Hammersley V. Married couples' risk of same disease: cross sectional study. BMJ. 2002;325:636. · DOI
  47. Di Castelnuovo A, Quacquaruccio G, Donati MB, de Gaetano G, Iacoviello L. Spousal concordance for major coronary risk factors: a systematic review and meta-analysis. Am J Epidemiol. 2009;169:1–8. · DOI
  48. Chen W, Srinivasan SR, Bao W, Berenson GS. The magnitude of familial associations of cardiovascular risk factor variables between parents and offspring are influenced by age: the Bogalusa Heart Study. Ann Epidemiol. 2001;11:522–8. · DOI
  49. Hu Y, He L, Wu Y, Ma G, Li L, Hu Y. Familial correlation and aggregation of body mass index and blood pressure in Chinese Han population. BMC Public Health. 2013;13:686. · DOI
  50. Vaezghasemi M, Ng N, Eriksson M, Subramanian SV. Households, the omitted level in contextual analysis: disentangling the relative influence of households and districts on the variation of BMI about two decades in Indonesia. Int J Equity Health. 2016;15:102. · DOI
  51. Meyler D, Stimpson JP, Peek MK. Health concordance within couples: a systematic review. Soc Sci Med. 2007;64:2297–310. · DOI
  52. Vandormael A, Newell ML, Barnighausen T, Tanser F. Use of antiretroviral therapy in households and risk of HIV acquisition in rural KwaZulu-Natal, South Africa, 2004-12: a prospective cohort study. Lancet Glob Health. 2014;2:e209–15. · DOI
  53. Callaghan-Koru JA, Gilroy K, Hyder AA, George A, Nsona H, Mtimuni A, Zakeyo B, Mayani J, Cardemil CV, Bryce J. Health systems supports for community case management of childhood illness: lessons from an assessment of early implementation in Malawi. BMC Health Serv Res. 2013;13:55. · DOI
  54. Hill Z, Manu A, Tawiah-Agyemang C, Gyan T, Turner K, Weobong B, Ten Asbroek AH, Kirkwood BR. How did formative research inform the development of a home-based neonatal care intervention in rural Ghana? J Perinatol. 2008;28(Suppl 2):S38–45. · DOI
  55. Kok MC, Muula AS. Motivation and job satisfaction of health surveillance assistants in Mwanza, Malawi: an explorative study. Malawi Med J. 2013;25:5–11.
  56. Moetlo GJ, Pengpid S, Peltzer K. An evaluation of the implementation of integrated community home-based care services in vhembe district, South Africa. Indian J Palliat Care. 2011;17:137–42. · DOI
  57. Nsabagasani X, Jesca Nsungwa S, Kallander K, Peterson S, Pariyo G, Tomson G. Home-based management of fever in rural Uganda: community perceptions and provider opinions. Malar J. 2007;6:11. · DOI
  58. Perez F, Ba H, Dastagire SG, Altmann M. The role of community health workers in improving child health programmes in Mali. BMC Int Health Hum Rights. 2009;9:28. · DOI
  59. Suri A, Gan K, Carpenter S. Voices from the field: perspectives from community health workers on health care delivery in rural KwaZulu-Natal, South Africa. J Infect Dis. 2007;196(Suppl 3):S505–11. · DOI
  60. Amare Y. Non-financial incentives for voluntary community health workers: a qualitative study. Vol. working paper no. 1. Addis Ababa: The Last Ten Kilometers Project, JSI Research & Training Institute; 2009.
  61. Lewis J. Final evaluation report. Busia Child Survival Project (BCSP). Washington, DC: African Medical and Research Foundation, USAID; 2010.
  62. Martinez R, Vivancos R, Visschers B, Namatovu L, Nyangoma E, Walley J. Training needs, practices and barriers in the work of community reproductive health workers in Masindi district, Uganda. Trop Dr. 2008;38:93–5. · DOI
  63. Puett C, Coates J, Alderman H, Sadler K. Quality of care for severe acute malnutrition delivered by community health workers in southern Bangladesh. Matern Child Nutr. 2013;9:130–42. · DOI
  64. Kebriaei A, Moteghedi MS. Job satisfaction among community health workers in Zahedan District, Islamic Republic of Iran. East Mediterr Health J. 2009;15:1156–63. · DOI

Cited by

Sorted by citations

Metadata

Authors
Geldsetzer, P., De Neve, J.-W., Boudreaux, C., Bärnighausen, T., & Bossert, T. J.
Affiliations
  • Harvard University (US)
  • Heidelberg University (DE)
Corresponding author
Geldsetzer, Pascal
ORCID
Venue
Human Resources for Health
Publisher
Springer Science and Business Media LLC
Published
2017-09-18
Volume
15
Issue
1
Pages
68-68
ISSN
1478-4491 (ISSN-L)
DOI
10.1186/s12960-017-0236-x
PMC
PMC5604406
OpenAlex
W2756313266
Cited by
35
References
1
Citations by year
2025: 3 · 2024: 8 · 2023: 6 · 2022: 5 · 2021: 5 · 2020: 2 · 2019: 4 · 2018: 2
FWCI
3.76
Type
journal article
Language
en
Open access
Licence
Locations
  • Human Resources for Health (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • heiDOK (Heidelberg University) (acceptedVersion, other-oa)
  • Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
United States Agency for International Development (FY13-S04-8800-00)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Global Health Workforce Issues
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
Keywords
community health workers, CHW performance, Swaziland, CHW training, career development, program reform, frontline health workers
MeSH terms
Workforce, Attitude of Health Personnel, Community Health Workers, Community Health Services, Female, Humans, Job Satisfaction, Mentors, Mothers, Motivation, Residence Characteristics, Eswatini, HIV Infections, Rural Health Services, Qualitative Research, Quality Improvement

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review