ArticleBMJ open2020
Understanding the importance of non-material factors in retaining community health workers in low-income settings: a qualitative case-study in Ethiopia.
Article in BMJ open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed.
- Mapping multilevel barriers impacting the performance of Ethiopia's Community-Based Health Extension Program: A scoping review.PloS one · 2026Article
- Financial motivation models for community health workers in low- and middle-income countries: a scoping review.Global health action · 2025Article
- Performance of community health volunteers during the COVID-19 pandemic: assessing the enablers and challenges in Machakos County, Kenya.Primary health care research & development · 2025Article
- An Overview of Data Collection in Health Preference Research.The patient · 2025Review
- Multidimensional performance enablers of Ethiopian community-based health extension program: A scoping review.PloS one · 2025Article
- The role of syndromic knowledge in Ethiopian veterinarians' treatment of cattle.Frontiers in veterinary science · 2024Article
- Training promotores to lead virtual hereditary breast cancer education sessions for Spanish-speaking individuals of Latin American heritage in California.BMC women's health · 2022Article
- Linking health worker motivation with their stated job preferences: A hybrid choice analysis in Ethiopia.Social science & medicine (1982) · 2022Article
- Community health workers' mobility in China: Evidence from 2008 to 2017.Frontiers in public health · 2022Article
- Changes in health worker knowledge and motivation in the context of a quality improvement programme in Ethiopia.Health policy and planning · 2021Article
- Stated job preferences of three health worker cadres in Ethiopia: a discrete choice experiment.Health policy and planning · 2021Article
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10 authors.
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Abstract
objectivesThe motivation and retention of community health workers (CHWs) is a challenge and inadequately addressed in research and policy. We sought to identify factors influencing the retention of CHWs in Ethiopia and ways to avert their exit.
designA qualitative study was undertaken using in-depth interviews with the study participants. Interviews were audio-recorded, and then simultaneously translated into English and transcribed for analysis. Data were analysed in NVivo 12 using an iterative inductive-deductive approach.
settingThe study was conducted in two districts each in the Tigray and Southern Nations, Nationalities and People's Republic (SNNPR) regions in Ethiopia. Respondents were located in a mix of rural and urban settings.
participantsLeavers of health extension worker (HEW) positions (n=20), active HEWs (n=16) and key informants (n=11) in the form of policymakers were interviewed.
resultsWe identified several extrinsic and intrinsic motivational factors affecting the retention and labour market choices of HEWs. While financial incentives in the form of salaries and material incentives in the form of improvements to health facility infrastructure, provision of childcare were reported to be important, non-material factors like HEWs' self-image, acceptance and validation by the community and their supervisors were found to be critical. A reduction or loss of these non-material factors proved to be the catalyst for many HEWs to leave their jobs.
conclusionOur study contributes new empirical evidence to the global debate on factors influencing the motivation and retention of CHWs, by being the first to include job leavers in the analysis. Our findings suggest that policy interventions that appeal to the social needs of CHWs can prove to be more acceptable and potentially cost-effective in improving their retention in the long run. This is important for government policymakers in resource constrained settings like Ethiopia that rely heavily on lay workers for primary healthcare delivery.
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