Motivating and demotivating factors for community health workers: a qualitative study in urban slums of Delhi, India

ABSTRACT

Background Community health workers play an important role in delivering health-care services, especiallyto underserved populations in low- and middle-income countries. They have been shown to be successfulin providing a range of preventive, promotive and curative services. This qualitative study investigated thefactors motivating or demotivating community health workers in urban settings in Delhi, India.Methods In this sub-study of the ANCHUL (Ante Natal and Child Healthcare in Urban Slums) implementationresearch project, four focus-group discussions and nine in-depth interviews were conducted with communityhealth workers and medical officers. Utilizing a reflexive and inductive qualitative methodology, the data setwas coded, to allow categories of motivating and demotivating factors to emerge.Results Motivating factors identified were support from family members for their work, improved self-identity,job satisfaction and a sense of social responsibility, prior experiences of ill health, the opportunity to acquirenew skills and knowledge, social recognition and status conferred by the community, and flexible workand timings. Negative experiences in the community and at health centres, constraints in the local healthsystem in response to the demand generated by the community health workers, and poor pay demotivatedcommunity health workers in this study, even causing some to quit their jobs.Conclusion Community-health-worker programmes that focus on ensuring the technical capacity of theirstaff may not give adequate attention to the factors that motivate or discourage these workers. As efforts getunder way to ensure universal access to health care, it is important that these issues are recognized andaddressed, to ensure that community health worker programmes are effective and sustainable.