Framework of Motivations
for Community Health Workers

JOHN LEE, ARIJIT SARKAR

Introduction

John Lee currently attends Cornell University majoring in Biology & Society with a concentration in Global Health. In his time at Cornell, he has been active in numerous global health initiatives. He is currently working on a malaria intervention project in Humjibre, Ghana, with a student organization called Cover Africa. His primary interest is to explore and repair areas in need of improvement in healthcare delivery and feasibility in existing or new paths.

Arijit Sarkar is Vice-President, Health Care Solutions at ICTPH. His primary interest is to invest in and provide support to socially relevant and sustainable business models, with a particular focus on nascent and early stage entrepreneurships. He has two years of financial modeling experience. His previous role was that of a quantitative research associate at Lehman Brothers, where he built models of liquidity in public equity markets. He has a bachelor’s degree in Electrical Engineering from IIT Bombay.

In both developed and developing countries, several Community Health Workers (CHW) programs have been established and implemented widely. Often drawn directly from the community, these workers act as a bridge for their communities and primary healthcare systems. The services that CHWs provide vary from education to basic clinical treatments. CHWs function as the workforce for countless interventions and community-based projects. The use of CHWs has been shown to improve cost-effectiveness in programs, while retaining similar outcomes to programs run by healthcare professionals (Mathauer).

Because of the volunteer-nature of community health work, motivation and incentives are particularly relevant in affecting the sustainability for interventions. Many programs suffer from high attrition rates, often leading to the collapse of projects. Since CHWs act as the link between the community and primary healthcare, the connection between the two is essential for the success of any intervention. Therefore, poor incentive structures reciprocally affect interventions. Incentives can play a strong role in the motivation of volunteers. A carefully devised incentive structure can not only create extrinsic motivators, but also aid in the development of volunteers in order to create environments where workers strive to achieve in their work. Once workers are intrinsically motivated to accomplish the program’s objectives, programs are more likely to be ultimately successful and effective in their interventions. Regardless of the failure of some programs, CHWs have been shown to be powerful forces in prevention, diagnosis, and treatment of diseases. In Nepal, CHWs were trained to diagnose and treat pneumonia, in which they eventually attained an 80% accuracy rate (Dawson et al). Because CHW programs have the potential to greatly improve healthcare, a comprehensive method in which to analyze motivations and incentives within a program would be invaluable to organizations trying to deploy community-based interventions.

Within the literature, many incentive options are proposed for increasing the motivation and sustainability of CHWs. Some programs have found success with monetary incentives, while others have found success by structurally improving their programs. Ultimately, incentive structures not only affect the motivation of CHWs, but the effectiveness of the program as a whole. Incentive structures should be developed in conjunction with, and not in addition to, the CHW program.

The goal of incentive structures should be to motivate CHWs to complete their tasks effectively, while ensuring that they will stay committed with the intervention. Motivation can be achieved in many ways, either extrinsically or intrinsically. In analyzing an intervention, it is important to distinguish the types of motivations, because they reflect on the type of incentive one can create. Motivations can be extrinsic, intrinsic, long term, short term, etc. A framework in which to analyze an intervention in order to distinguish different types of motivations will be proposed, based on A.H. Maslow’s Theory of Human Motivation. This framework will contain aspects of other psychological theories of motivation, corporate management models, and volunteer management models. Applying Maslow’s theory to existing corporate management models will establish the theory’s relevance to management structures. Because volunteer work differs from corporate work, the Theory of Human Motivation will be adapted to non-paid, volunteer work. The framework will then be applied to major areas of existing CHW programs in order to review the incentives, and ultimately, the motivators in place. This will identify common trends and problems, which will provide a basis of information in which specific details of the Nala Oli project in Karambayam can be reviewed and analyzed. After the motivators have been identified and distinguished in the Nala Oli project, recommendations of possible incentive structures will be proposed. More importantly, a system in analyzing a specific CHW program will be delineated. Table 1 below outlines the logic this paper will follow in developing a framework in which to analyze CHW programs.

Framework of Article

Application of Theory of Human Motivation

Purpose

Output

Corporate Business Models
  • To provide broad evidence of the relevance of Maslow’s Theory of Human Motivation to management models and practices
  • Maslow’s Needs Hierarchy

Volunteer Management Models
  • To adapt Maslow’s Needs Hierarchy to volunteer management
  • Provide differences between corporate and volunteer management models
  • Relevant Need’s Hierarchy framework for volunteer management

Existing CHW Programmes
  • Apply common areas of concern for existing CHW programs to Need’s Hierarchy Framework
  • Identify common trends and problems
  • Model of analyzing program motivators through Need’s Hierarchy framework
  • Common trends and problems of CHW programs

Nala Oli Project
  • Identify problems and deficits within Nala Oli project
  • Specific approach to program analysis
  • Recommendations for Nala Oli Project
  • Model of analyzing a specific program through Need’s Hierarchy framework

This paper will provide a systematic method in which to analyze the motivational structure of CHWs. The proposal aims to develop a method in which to create programs that not only have incentives, but are effective and sustainable.

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