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Background: Volunteer community health workers (VCHW) are health care providers who are trained but do not have any professional certification. They are intended to fill the gap for unmet curative, preventative, and health promotion health needs of communities. This study aims to investigate the non-financial incentives for VCHWs and factors affecting their motivation.Methods: A cross-sectional quantitative study was performed from February to March 2013. A total of 400 randomly selected female VCHWs were included using the district health office registers. Finally, multivariate logistic regression was used to determine the independent predictors of VCHW motivation.Results: Significant numbers (48%) of study participants have mentioned future training as a major non-financial incentive. Age between 20 and 36 years old (adjusted odds ratio (AOR) = 1.45, 95% CI = 1.18, 2.13), married VCHWs (AOR = 3.84, 95% CI = 1.73, 5.02), presence of children under five years old (AOR = 0.2, 95% CI = 0.09, 0.71), allowing volunteer withdrawal (AOR = 1.35, 95% CI = 1.06, 2.47), and establishment of a local endowment fund for community health workers after they left volunteerism (AOR = 1.11, 95% CI = 1.05, 1.91) are all factors associated with VCHW motivation.Conclusions: Future training was mentioned as the prime non-financial incentive. Age, marital status, presence of children under five, allowing volunteer withdrawal, and establishment of a local endowment fund were identified as the independent predictors of motivation. Therefore, considering a non-financial incentive package, including further training and allowing volunteer withdrawal, would be helpful to sustain volunteerism.
This community-based cross-sectional study was performed from February to March 2013, in Kilte Awlaelo district, Tigray regional state, located 829 km north of Addis Ababa. Based on the projection of the 1994 census, in 2008 the total population of the district was 157,500 [9], with a total of 24,615 households in the district. The Health Extension Program was launched by the Government of Ethiopia in 2005 to improve access to basic health services to the rural population. At the local level, the implementation of the Health Extension Program is based on the construction of health posts and the deployment of female Health Extension Workers (HEWs). HEWs have received one-year training and engage in disseminating preventive health messages and providing selected curative services. HEWs also train, mentor, support, and supervise VCHWs [10]. In Ethiopia, VCHWs are community members who are trained to become model families and who subsequently work to share health information with their communities towards achieving better health outcomes [11]. Training of VCHWs was given by HEWs at the local health post in most cases. The issues covered in the training of VCHWs generally focus on hygiene and sanitation, antenatal care, immunization, delivery care, maternal and infant nutrition, growth monitoring, family planning, and malaria. Every VCHW is typically given responsibility over five households in their community in most regions of Ethiopia and five mothers in the Tigray region, to whom they promote positive health practices through household visits [11]. All VCHWs working in Kilte Awlealo district were included. Sample size was determined with the assumption of single population proportion considering 0.5 previous proportion, 5% margin of error and 95% confidence intervals (CI) and 5% non-response rate and the final sample size was computed to be 400. In Kilte Awlealo district there are 19 kebelles (the smallest administrative unit in Ethiopia) and the population of each kebelle ranges from 4,779 to 12,595. The number of households in each kebelle ranges from 956 to 2,519 and there are on average more than 290 VCHWs per kebelle. Based on this, simple random sampling proportional to size was used to select the study subjects (VCHWs) using the health office and HEW registers. A structured face-to-face interview questionnaire, which includes socio-demographic and other characteristics that can measure non-financial incentives and motivation of VCHWs, was used. The questionnaire was prepared in English first and then translated in to the local language, Tigrigna, and was developed after a literature review [8, 10–14]. Ten experienced data collectors were hired to collect the data and one day training on the content and methods of data collection was given for data collectors and supervisors. Supervision was also performed on the spot by supervisors and principal investigators. Moreover, the data collection tool was pretested in 5% of the total sample size in areas that were not included in the final study. Finally, data cleaning and cross-checking was carried out before analysis. After checking for completeness and consistency of the data on the field, it was entered into Epi-Info 2005 version 3.5.2. Finally, data was exported to SPSS version 16 and cleaned by running frequencies. Exploratory data analysis was carried out to check the level of incompleteness and inconsistencies. Description of participant’s characteristics was performed by percentages. Additionally, the non-financial incentives mentioned by VCHWs were summarized by percentages. The outcome variable (motivation) of VCHWs was measured by ten index, equal weight questions (yes = 1/no = 0) and the above median value score of the index questions was used as the cutoff point to classify as motivated or not. Finally, percentage was used to summarize the outcome variable (motivation VCHWs). Bivariate logistic regression was carried out to see the crude relationship of each independent variable with the outcome variable (motivation of VCHWs). Variables which were found to be significant at P <0.05 were taken to the multivariate logistic regression to see the independent predictors of motivation of VCHWs. In the model-building procedure, a stepwise back ward regression technique was applied. Proportions and odds ratios with 95% CI were used to interpret results of the study. Ethical approval and clearance was obtained from Mekelle University, College of Health Sciences Ethical review committee. A formal cooperation letter was obtained from Mekelle University and Tigray Regional Health Bureau. Verbal consent was obtained from the study participants after explaining the objective, benefits and harms of the study because the participants couldn’t read and write. The right of participants to anonymity and confidentiality was ensured by excluding personal identifiers.
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