What is the impact of removing performance-based financial incentives on community health worker motivation? A qualitative study from an infant and young child feeding program in Bangladesh
Abstract Background Community health worker (CHW) motivation is an important factor related to health service quality and CHW program sustainability in low- and middle-income countries. Financial and non-financial motivators may influence CHW behavior through two dimensions of motivation: desire to...
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| Format: | Article |
| Language: | English |
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BMC
2021-09-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12913-021-06996-y |
| _version_ | 1818718408121778176 |
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| author | Jeffrey Glenn Corrina Moucheraud Denise Diaz Payán Allison Crook James Stagg Haribondhu Sarma Tahmeed Ahmed Adrienne Epstein Sharmin Khan Luies Mahfuzur Rahman Margaret E. Kruk Thomas J. Bossert |
| author_facet | Jeffrey Glenn Corrina Moucheraud Denise Diaz Payán Allison Crook James Stagg Haribondhu Sarma Tahmeed Ahmed Adrienne Epstein Sharmin Khan Luies Mahfuzur Rahman Margaret E. Kruk Thomas J. Bossert |
| author_sort | Jeffrey Glenn |
| collection | DOAJ |
| description | Abstract Background Community health worker (CHW) motivation is an important factor related to health service quality and CHW program sustainability in low- and middle-income countries. Financial and non-financial motivators may influence CHW behavior through two dimensions of motivation: desire to perform and effort expended. The aim of this study was to explore how the removal of performance-based financial incentives impacted CHW motivation after formal funding ceased for Alive and Thrive (A&T), an infant and young child feeding (IYCF) program in Bangladesh. Methods This qualitative study included seven focus groups (n = 43 respondents) with paid supervisors of volunteer CHWs tasked with delivering interpersonal IYCF counseling services. Data were transcribed, translated into English, and then analyzed using both a priori themes and a grounded theory approach. Results Results suggest the removal of financial incentives was perceived to have negatively impacted CHWs’ desire to perform in three primary ways: 1) a decreased desire to work without financial compensation, 2) changes in pre- and post-intervention motivation, and 3) household income challenges due to dependence on incentives. Removal of financial incentives was perceived to have negatively impacted CHWs’ level of effort expended in four primary ways: 1) a reduction in CHW visits, 2) a reduction in quality of care, 3) CHW attrition, and 4) substitution of other income-generating activities. Conclusions This study provides new evidence regarding how removing performance-based financial incentives from a CHW program can negatively impact CHW motivation. The findings suggest that program decision makers should consider how to construct community health work programs such that CHWs may continue to receive performance-based compensation after the original funding ceases. |
| first_indexed | 2024-12-17T19:50:34Z |
| format | Article |
| id | doaj.art-ebee928cb63349c688d4a642709898c3 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-17T19:50:34Z |
| publishDate | 2021-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-ebee928cb63349c688d4a642709898c32022-12-21T21:34:44ZengBMCBMC Health Services Research1472-69632021-09-0121111110.1186/s12913-021-06996-yWhat is the impact of removing performance-based financial incentives on community health worker motivation? A qualitative study from an infant and young child feeding program in BangladeshJeffrey Glenn0Corrina Moucheraud1Denise Diaz Payán2Allison Crook3James Stagg4Haribondhu Sarma5Tahmeed Ahmed6Adrienne Epstein7Sharmin Khan Luies8Mahfuzur Rahman9Margaret E. Kruk10Thomas J. Bossert11Department of Public Health, College of Life Sciences, Brigham Young UniversityDepartment of Health Policy and Management, University of California Los Angeles, Fielding School of Public HealthDepartment of Public Health, School of Social Sciences, Humanities and Arts, University of California MercedDepartment of Public Health, College of Life Sciences, Brigham Young UniversityDepartment of Public Health, College of Life Sciences, Brigham Young UniversityResearch School of Population Health, Australian National UniversityNutrition and Clinical Services Division, icddr,bDepartment of Epidemiology and Biostatistics, University of CaliforniaNutrition and Clinical Services Division, icddr,bNutrition and Clinical Services Division, icddr,bDepartment of Global Health and Population, Harvard T.H. Chan School of Public HealthDepartment of Global Health and Population, Harvard T.H. Chan School of Public HealthAbstract Background Community health worker (CHW) motivation is an important factor related to health service quality and CHW program sustainability in low- and middle-income countries. Financial and non-financial motivators may influence CHW behavior through two dimensions of motivation: desire to perform and effort expended. The aim of this study was to explore how the removal of performance-based financial incentives impacted CHW motivation after formal funding ceased for Alive and Thrive (A&T), an infant and young child feeding (IYCF) program in Bangladesh. Methods This qualitative study included seven focus groups (n = 43 respondents) with paid supervisors of volunteer CHWs tasked with delivering interpersonal IYCF counseling services. Data were transcribed, translated into English, and then analyzed using both a priori themes and a grounded theory approach. Results Results suggest the removal of financial incentives was perceived to have negatively impacted CHWs’ desire to perform in three primary ways: 1) a decreased desire to work without financial compensation, 2) changes in pre- and post-intervention motivation, and 3) household income challenges due to dependence on incentives. Removal of financial incentives was perceived to have negatively impacted CHWs’ level of effort expended in four primary ways: 1) a reduction in CHW visits, 2) a reduction in quality of care, 3) CHW attrition, and 4) substitution of other income-generating activities. Conclusions This study provides new evidence regarding how removing performance-based financial incentives from a CHW program can negatively impact CHW motivation. The findings suggest that program decision makers should consider how to construct community health work programs such that CHWs may continue to receive performance-based compensation after the original funding ceases.https://doi.org/10.1186/s12913-021-06996-yCommunity health workerFinancial incentivesMotivationHealth workforceHealth systemsChild health |
| spellingShingle | Jeffrey Glenn Corrina Moucheraud Denise Diaz Payán Allison Crook James Stagg Haribondhu Sarma Tahmeed Ahmed Adrienne Epstein Sharmin Khan Luies Mahfuzur Rahman Margaret E. Kruk Thomas J. Bossert What is the impact of removing performance-based financial incentives on community health worker motivation? A qualitative study from an infant and young child feeding program in Bangladesh BMC Health Services Research Community health worker Financial incentives Motivation Health workforce Health systems Child health |
| title | What is the impact of removing performance-based financial incentives on community health worker motivation? A qualitative study from an infant and young child feeding program in Bangladesh |
| title_full | What is the impact of removing performance-based financial incentives on community health worker motivation? A qualitative study from an infant and young child feeding program in Bangladesh |
| title_fullStr | What is the impact of removing performance-based financial incentives on community health worker motivation? A qualitative study from an infant and young child feeding program in Bangladesh |
| title_full_unstemmed | What is the impact of removing performance-based financial incentives on community health worker motivation? A qualitative study from an infant and young child feeding program in Bangladesh |
| title_short | What is the impact of removing performance-based financial incentives on community health worker motivation? A qualitative study from an infant and young child feeding program in Bangladesh |
| title_sort | what is the impact of removing performance based financial incentives on community health worker motivation a qualitative study from an infant and young child feeding program in bangladesh |
| topic | Community health worker Financial incentives Motivation Health workforce Health systems Child health |
| url | https://doi.org/10.1186/s12913-021-06996-y |
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