Interventions to Improve Motivation and Retention of Community Health Workers Delivering Integrated Community Case Management (iCCM): Stakeholder Perceptions and Priorities
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Despite resurgence in the use of community health workers (CHWs) in the delivery of community case management of childhood illnesses, a paucity of evidence for effective strategies to address key constraints of worker motivation and retention endures. This work reports the results of semi-structured interviews with 15 international stakeholders, selected because of their experiences in CHW program implementation, to elicit their views on strategies that could increase CHW motivation and retention. Data were collected to identify potential interventions that could be tested through a randomized control trial. Suggested interventions were organized into thematic areas; cross-cutting approaches, recruitment, training, supervision, incentives, community involvement and ownership, information and data management, and mHealth. The priority interventions of stakeholders correspond to key areas of the work motivation and CHW literature. Combined, they potentially provide useful insight for programmers engaging in further enquiry into the most locally relevant, acceptable, and evidence-based interventions.
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mHealth can support the performance of health care workers by disseminating clinical updates, learning materials, and reminders, particularly in underserved rural locations in low- and middle-income countries where community health workers deliver integrated community case management to children with diarrhea, pneumonia, and malaria.
“mHealth can also support the performance of health care workers by the dissemination of clinical updates, learning materials, and reminders [3], particularly in underserved rural locations in low- and middle-income countries where community health workers deliver ICCM to children sick with diarrhea, pneumonia, and malaria [3,4].”
From Mobile Health (mHealth) Approaches and Lessons for Increased Performance and Retention of Community Health Workers in Low- and Middle-Income Countries: A Review (2013) · cites this paper as [4]
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Experimental — accuracy not yet measuredMobile phones present opportunities for community health workers to communicate directly with one another and provide peer support.
“Mobile phones also present opportunities for community health workers to communicate directly with one another and provide peer support [4].”
Mobile phone-assisted data collection in a Rwandan ICCM program became onerous and was felt to have distanced community health workers from the human side of their role, turning them into "data collection robots."
“However, use of PDAs in a Rwandan ICCM program exacerbated, rather than lessened, volunteer workload [4]; mobile phone-assisted data collection became onerous and was felt to have distanced community health workers from the human side of their role, turning them into “data collection robots.””
From Mobile Health (mHealth) Approaches and Lessons for Increased Performance and Retention of Community Health Workers in Low- and Middle-Income Countries: A Review (2013) · cites this paper as [4]
The Discussion (page unavailable) cautions that technology should not become a disproportionate focus and says CHW data collection should be simple and meaningful. But our copy does not report a Rwandan iCCM program in which mobile-phone data collection became onerous or workers felt like “data collection robots” (searched: Rwanda, robots, onerous, and PDA workload). (LLM, conf=0.76)
Experimental — accuracy not yet measuredUse of PDAs in a Rwandan ICCM program exacerbated, rather than lessened, volunteer workload.
“However, use of PDAs in a Rwandan ICCM program exacerbated, rather than lessened, volunteer workload [4]; mobile phone-assisted data collection became onerous and was felt to have distanced community health workers from the human side of their role, turning them into “data collection robots.””
From Mobile Health (mHealth) Approaches and Lessons for Increased Performance and Retention of Community Health Workers in Low- and Middle-Income Countries: A Review (2013) · cites this paper as [4]
The Discussion discusses mobile phones for CHW data collection and cautions that technology should not become a disproportionate focus. But our copy does not report a Rwandan iCCM program, PDA use, or an increase in volunteer workload (searched: Rwanda, PDAs, workload, and data-collection burden). (LLM, conf=0.76)
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- Authors
- Strachan, D. L., Källander, K., ten Asbroek, A. H. A., Kirkwood, B., Meek, S. R., Benton, L., Conteh, L., Tibenderana, J., & Hill, Z.
- Affiliations
- Malaria Consortium (GB)
- Corresponding author
- Strachan, Daniel L.
- ORCID
- Venue
- The American Journal of Tropical Medicine and Hygiene
- Published
- 2012-11-07
- Volume
- 87
- Issue
- 5_Suppl
- Pages
- 111-119
- ISSN
- 0002-9637 (ISSN-L)
- 1476-1645
- PMC
- PMC3748511
- OpenAlex
- W2141968889
- Cited by
- 144
- References
- 26
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 6 · 2023: 6 · 2022: 5 · 2021: 11 · 2020: 13 · 2019: 13 · 2018: 17 · 2017: 21 · 2016: 11 · 2015: 13 · 2014: 12 · 2013: 6 · 2012: 1
- FWCI
- 17.58
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- American Journal of Tropical Medicine and Hygiene (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- Bill and Melinda Gates Foundation
- London School of Hygiene and Tropical Medicine
- Imperial College London
- University College London
- Topics
- Health Sciences › Health Professions › Emergency Medical Services › Global Health Workforce Issues
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Keywords
- community health workers, integrated community case management, employee motivation, employee retention, stakeholder perspectives, childhood diseases, recruitment and training, supervision, incentives, community participation, mobile health, data management
- MeSH terms
- Workforce, Community Health Workers, Community Health Services, Humans, Motivation, Perception, Databases, Factual, Delivery of Health Care, Integrated, Case Management
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