Beyond Institutionalization: Planning for Sustained Investments in Training, Supervision, and Support of Community Health Worker Programs in Bangladesh
| Autor: | Shongkour Roy, Shivani Pandya, Md. Irfan Hossain, Timothy Abuya, Charlotte E. Warren, Paloma Mitra, Ubaidur Rob, Sharif Hossain, Smisha Agarwal |
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| Rok vydání: | 2021 |
| Předmět: | |
| Zdroj: | Global Health: Science and Practice |
| ISSN: | 2169-575X |
| DOI: | 10.9745/ghsp-d-21-00156 |
| Popis: | Institutionalizing community health workers (CHWs) is insufficient for improving program quality. Governments must plan for sustained investments for salaries and benefits, as well as systems enabling adaptive management of the CHW cadres. Greater coordination is needed at the global level to pool and align donor investments to support the ecosystem underlying CHW programs. Key Findings The community health worker (CHW) program in Bangladesh faces many systemic challenges related to inadequate technical recognition, training opportunities, identification as government employees, access to transportation, provision of working tools, and the workplace environment.The study highlighted tensions between family welfare assistants and health assistants owing to differences in their compensation structures despite comparable responsibilities—a situation that has resulted in demoralization of the cadres.Despite being institutionalized, the challenges faced by the CHW cadres in Bangladesh are very similar to CHW programs in other countries, highlighting the need to move beyond institutionalization to sustained investments in a supportive ecosystem for CHW programs. Key Implications Changes to technical ranks and wages for the health care sector need to take a sector-wide lens so that wages for all health care workers can be systematically calibrated.Efforts to institutionalize CHWs should be accompanied by plans for sustained investments in and support for training, adequate compensation, supervision, access to working tools, and recognition of CHWs. Introduction: Bangladesh has a long history of mature and institutionalized community health worker (CHW) programs in primary health care. However, there is a lot of variability in the performance of the CHW programs in Bangladesh, as well as challenges associated with retention of CHWs. This study describes the challenges for CHWs, which in turn affect their motivation and performance. Methods: This study was conducted from December 2019 to January 2020 in 4 districts in Bangladesh: Cox's Bazar, Khulna, Rajshahi, and Sylhet. Twenty focus group discussions were conducted with 121 participants, including family welfare assistants (FWA), health assistants (HA), and their direct supervisors. Thirty in-depth interviews were conducted with upazila and district-level stakeholders. Data were analyzed using a thematic approach with a particular focus on CHW motivation, job satisfaction, and incentive preferences for improving morale and performance. Results: Several nonmonetary and monetary factors affect CHWs' motivation, performance, and job satisfaction. Recognition by the community, availability of promotions and technical recognition, increased training opportunities, reduced workloads, identification as government employees, access to transportation, provision of working tools, and improvements in the workplace environment were identified as important nonmonetary incentives. CHWs also discussed the importance of sufficient salaries and allowances. Discussion: Several factors impede the effectiveness of the CHW programs in Bangladesh. Changes to technical ranks and wages for the health care sector need to take a sector-wide lens to enable systematic calibration of wages for all health care workers. This study highlights that institutionalization of CHWs without adequate and sustained support for continued training, compensation, supervision, access to working tools, and recognition is insufficient to drive change. Identifying pragmatic strategies that can be supported through existing government budgets to address these factors is vital to sustaining the community health workforce in Bangladesh. |
| Databáze: | OpenAIRE |
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