ArticleBMC public health2019
What can motivate Lady Health Workers in Pakistan to engage more actively in tuberculosis case-finding?
Article in BMC public health, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it, 32 citations in OpenAlex.
- Community views on active case finding for tuberculosis in low- and middle-income countries: a qualitative evidence synthesis.The Cochrane database of systematic reviews · 2024Pooled it
- Community health worker involvement across domains and national infectious disease programmes in rural Madagascar: evidence of fragmentation and determinants of engagement.BMJ global health · 2026Article
- Global status of policies and practices for systematic TB screening in high-burden countries.IJTLD open · 2025Article
- Financial motivation models for community health workers in low- and middle-income countries: a scoping review.Global health action · 2025Article
- Community Empowerment through Cadres in the Tuberculosis Program: A Scoping Review.Iranian journal of public health · 2025Review
- Individual, community and health systems factors influencing time to notification of tuberculosis: situating software and hardware bottlenecks in local health systems.BMC health services research · 2024Article
- Motivation and job satisfaction of community health workers in Ethiopia: a mixed-methods approach.Human resources for health · 2023Article
- 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 · 2021Article
- A Multi-Faceted Approach to Tuberculosis Active Case Finding among Remote Riverine Communities in Southern Nigeria.International journal of environmental research and public health · 2021Article
- Understanding the role of lady health workers in improving access to eye health services in rural Pakistan - findings from a qualitative study.Archives of public health = Archives belges de sante publique · 2021Article
- Interplaying role of healthcare activist and homemaker: a mixed-methods exploration of the workload of community health workers (Accredited Social Health Activists) in India.Human resources for health · 2021Article
- Effectiveness of a health education intervention on the use of long-lasting insecticidal nets for the prevention of malaria in pregnant women of Pakistan: a quasi-experimental study.Malaria journal · 2020Article
- Is enhancing the professionalism of healthcare providers critical to tackling antimicrobial resistance in low- and middle-income countries?Human resources for health · 2020Article
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Authors and funding
7 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundMany interventions to motivate community health workers to perform better rely on financial incentives, even though it is not clear that monetary gain is the main motivational driver. In Pakistan, Lady Health Workers (LHW) are responsible for delivering community level primary healthcare, focusing on rural and urban slum populations. There is interest in introducing large-scale interventions to motivate LHW to be more actively involved in improving tuberculosis case-finding, which is low in Pakistan.
methodsOur study investigated how to most effectively motivate LHW to engage more actively in tuberculosis case-finding. The study was embedded within a pilot intervention that provided financial and other incentives to LHW who refer the highest number of tuberculosis cases in three districts in Sindh province. We conducted semi-structured interviews with 20 LHW and 12 health programme managers and analysed these using a framework categorising internal and external sources of motivation.
resultsInternal drivers of motivation, such as religious rewards and social recognition, were salient in our study setting. While monetary gain was identified as a motivator by all interviewees, programme managers expressed concerns about financial sustainability, and LHW indicated that financial incentives were less important than other sources of motivation. LHW emphasised that they typically used financial incentives provided to cover patient transport costs to health facilities, and therefore financial incentives were usually not perceived as rewards for their performance.
conclusionsThis study indicated that interventions in addition to, or instead of, financial incentives could be used to increase LHW engagement in tuberculosis case-finding. Our finding about the strong role of internal motivation (intrinsic, religious) in Pakistan suggests that developing context-specific strategies that tap into internal motivation could allow infectious disease control programmes to improve engagement of community health workers without being dependent on funding for financial incentives.
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