Understanding community health worker incentive preferences in Uganda using a discrete choice experiment

Bibliographic Data

ID19552146
AuthorsSmisha Agarwal (0000-0002-7407-0066, Johns Hopkins University, corresponding author), Timothy Abuya (0000-0001-8815-8299, British Council), Richard Kintu (Formally Pathfinder International, Kampala, Uganda), Daniel Mwanga (0000-0003-3907-1538, British Council), Melvin Obadha (0000-0003-1632-2410, University of Oxford), Shivani Pandya (0000-0003-3524-9861, Johns Hopkins University), Charlotte E Warren (Population Council, Washington, D.C., USA), Charlotte Warren (0000-0002-1361-2618, Population Council)
Year2021
Volume11
Pages07005-07005
Publication date2021-03-10
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueJournal of Global Health (JOURNAL)
Journal identifiersISSN: 2047-2978 • E-ISSN: 2047-2986
PublisherInternational Global Health Society (PUBLISHER)
DOI10.7189/jogh.11.07005
PMID33763219
OpenAlexW3137430648
LanguageEN
Citations received9
References cited32

BACKGROUND: Community health workers (CHWs) play a critical role in supporting health systems, and in improving the availability and accessibility to health care. However, CHW programs globally continue to face challenges with poor performance and high levels of CHW attrition. CHW programs are often underfunded and poorly planned, which can lead to loss of motivation by CHWs. The study aims to determine preferences of CHWs for job incentives with the goal of furthering their motivation and success. METHODS: Relevant incentive attributes were identified through focus group discussions and in-depth interviews with CHWs, non-governmental organization CHWs, CHW supervisors, and policy-level stakeholders. Based on seven attributes (eg, training, workload, stipend) we developed a discrete choice experiment (DCE) that was administered to 399 CHWs across eight districts in Uganda. We used conditional and mixed multinomial logit models to estimate the utility of each job attribute. We calculated the marginal willingness to accept as the trade-off the CHWs were willing to make for a change in salary. RESULTS: CHWs preferred higher salaries, though salary was not the most important attribute. There was a preference for reliable transportation, such as a bicycle (β = 1.86, 95% CI = 1.06, 2.67), motorcycle (β = 1.81, 95% CI = 1.27, 2.34) or transport allowance (β = 1.37, 95% CI = 0.65, 2.10) to no transport. Formal identification including identity badges (β = 1.61, 95% CI = 0.72, 2.49), branded uniforms (β = 1.04, 95% CI = 0.45, 1.63) and protective branded gear (β = 0.76, 95% CI = 0.32, 1.21) were preferred compared to no identification. CHWs also preferred more regular refresher trainings, the use of mobile phones as job-aids and a lesser workload. The relative importance estimates suggested that transport was the most important attribute, followed by identification, refresher training, salary, workload, recognition, and availability of tools. CHWs were willing to accept a decrease in salary of USH 31 240 (US$8.5) for identity badges, and a decrease of USH85 300 (US$23) for branded uniforms to no identification. CONCLUSIONS: This study utilized CHW and policymaker perspectives to identify realistic and pragmatic incentives to improve CHW working conditions, which is instrumental in improving their retention. Non-monetary incentives (eg, identification, transportation) are crucial motivators for CHWs and should be considered as part of the compensation package to facilitate improved performance of CHW programs

Attrition · Business · Economics · Environmental health · Health facility · Health services · Incentive · Multinomial logistic regression · Population · Salary · Workload · Global Health Workforce Issues · Global Maternal and Child Health · Healthcare Systems and Reforms · Medicine · Nursing · Psychology

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