Factors associated with performance motivation of community health volunteers implementing integrated community case management programme in Homa-bay county, Kenya

Abstract

Globally, the integration of community health workers (CHWs) in healthcare delivery is widening. CHWs are very important if the universal provision of healthcare and the third Sustainable Development Goals are to be met. However, these CHWs are volunteers hence they need to be highly motivated to ensure effective performance of their responsibilities. Despite the importance of performance motivation and its association with health service delivery, the CHWs performance motivation in Homa Bay County remains unknown. As such, the current study assessed the factors associated with CHWs performance motivation in Homa Bay County in Kenya using a mixed method approach. The specific objectives were to assess the current level of performance motivation among the CHWs in Homa Bay County, to determine the factors affecting CHWs level of performance motivation, to assess CHWs perceptions of the current status of the motivational determinants and to assess CHWs experiences on the current status of the motivational determinants. This cross-sectional study design employed both qualitative and quantitative techniques. The study targeted the CHWs implementing Integrated Community Case Management (iCCM) program. The sample size was 359 CHWs drawn from a total population of 2159. Data was collected using questionnaires and focused group discussions. In order to assess level of performance motivation, questionnaires with Likert scale responses was used. Quantitative data was summarized using descriptive statistics. To assess the association between two numerical variables, correlation analysis was used. T-test and analysis of variance (ANOVA) were used to compare means for groups. Qualitative data was coded and thematically analyzed. A response rate of 99.1% (n=323) was achieved. Majority of the respondents were female (75.8%), 41 years old and above (35%), and married (75.2%). Majority of the respondents (57.3%) had secondary education as the highest level of education attained and most of them (66.3%) get their source of livelihood from agriculture. The overall level of performance motivation for CHWs implementing iCCM program in Homa Bay County is 3.93 (SD=0.26, n=323). The level of motivation was highest on individual factors (mean=4.22, SD=0.304) followed by community factors (mean=3.78, SD=0.290) and the least on health facility factors (mean=3.60, SD=0.431). Training (p=0.001), availability of stock (p=0.006) and recognition (p=0.006) had a significant effect on the level of performance motivation. Social responsibility and altruism, community and peer support, training, incentives and recognition emerged as motivators while excessive workload, poor roads and lack of means of transport, frequent stock-outs, lack of airtime and mobile phones for communication and poor referral systems emerged as demotivators. Provision of means of transport, consistent supplies of stocks, frequent refresher trainings and additional incentives are recommended to improve the level of performance motivation. The study results are useful in developing ways of motivating CHWs to achieve maximum performance and enhance effectiveness of the iCCM program.