Background
Methods
Procedures and participants
Bangladesh | Ethiopia | Indonesia | Kenya | Malawi | Mozambique | |
---|---|---|---|---|---|---|
Close-to-community provider acronym and basic typology | CTC health provider (volunteers) | HEW (government payroll) | Village midwives (government payroll)/kaders (volunteers) | CHEW (government payroll)/CHV (volunteers) | HSA (government payroll) | APE (volunteers) |
Sampling method | Convenience | Convenience | Convenience | Convenience | Random | Convenience |
Language | Bangla | Amharic | Basha-Indonesia | English, Swahili, Kamba | Chichewa | Portuguese, Ronga, Changane |
Sample size | 119 | 108 | 230 | 51 | 124 | 78 |
Sex (female, %) | 75.6 | 100 | 97.0 | 76.5 | 38.7 | 61.5 |
Completed secondary education (%) | 12.3 | 99.1 | 28.3 | 34.1 | 79.5 | 0 |
Specific study procedures and data analysis
Phase I—Interviews and focus group discussions with CTC providers
Phase II—Literature review
Phase III—Tool refinement and validation
Results
Phase I—Interviews and focus group discussion with CTC providers
…we are the eyes of the Ministry of Health in this country and we also are a shield when it comes to protecting the community’s health. [The community] people always come to us before they go anywhere and yet the authorities seem not to care about us at all… Health Surveillance Assistant, FGD, Malawi
The Health Extension Programme is hard working and very exhaustive, but the government does not realize it. Health Extension Worker, Interview, Ethiopia
Now the Kaders don’t have motivation to do the vaccination because there is no support for their transportation. Kader CHW, Interview, Indonesia
It is not fair, it is not fair, it is not fair [the supervision], because it does not motivate me… it mostly entails administration because they just come for fault finding. Community Health Extension Worker, Interview, Kenya
In fact in 2005 EC we made our kebele (community) free of open field defecation. During that time we receive recognition from our kebele and from woreda health office. This motivates me to work hard further. Community Health Worker, Interview, Ethiopia
Also with the supervision we can communicate directly about our needs. The supervision increases my motivation and also improve my knowledge. It keeps me motivated. Kader CHW, Interview, Indonesia
…We feel well appreciated by the people we help and this encourages us to continue doing our work. This appreciation makes us feel proud that we are doing a good job. Health Surveillance Assistant, FGD, Malawi
Delivery in hospitals is very expensive. My motivation behind working here [in the community] is to serve the people [in the community]. CTC Provider, Bangladesh
If they (community) listen to me then I’m motivated to do my job. An award like trophy can be bought but their gratitude as the appreciation cannot be bought...... I have sacrificed my time with my family to work for the community. And if they still do not want to listen to me that makes me sad. If they listen it makes me happy, because it means I’m successful and vice versa. Community Health Worker, Interview, Indonesia
It gives me pleasure when I see malnourished children getting well after receiving treatment from me. Health Extension Worker, Interview, Ethiopia
Since my childhood I was interested to serve the humanity, for this reason I choose this profession. At the same time I noticed the high demand of Ayurvedic and Unani [herbal] medicine along with these [52] medicines, so for this reason I joined this profession. Informal CTC provider – drug store salesman, Interview, Bangladesh
I’m proud with my job as a kader, because I realize that this job is a social work. When they were asking me to become a kader, I thought that I would get an experience and give my worship to God as well. Kader, Interview, Indonesia
Phase II—Literature review
Factor | Source(s)/use(s) | Items | Comments |
---|---|---|---|
Organisational commitment | (Mbindyo et al., 2009, Prytherch et al., 2012, Mutale et al., 2013, Penn-Kekana et al., 2005, Bennett et al., 2001) | I am proud to be working for my organisation as a CTC provider (OC1) | In each context, the word ‘organisation’ was adapted from ‘hospital’ or ‘health facility’ used in other questionnaires. In most of the six countries, the organisation was identified as the Ministry of Health. |
(Mutale et al., 2013, Mbindyo et al., 2009, Penn-Kekana et al., 2005, Bennett et al., 2001, Brunie et al., 2014) | I feel very little commitment to my organisation (OC2) | ||
(Mutale et al., 2013, Mbindyo et al., 2009, Bennett et al., 2001) | My organisation really inspires me to do the very best on the job (OC3) | ||
Extrinsic job satisfaction | Phase I findings as well as adapted from Mutale et al., 2013, Mbindyo et al., 2009 | I am satisfied with the support I receive from my colleagues (JS1) | Satisfaction with the support from colleagues, community, and supervisor all identified as important during phase I data analysis. |
(Bennett et al., 2001, Prytherch et al., 2012) | I am satisfied with the opportunities for further training I have on this job (JS2) | ||
Phase I findings | I am satisfied with the community thanks and recognition I receive for my work (JS3) | ||
Phase I findings and adapted from Prytherch et al., 2012, Brunie et al., 2014, Penn-Kekana et al., 2005, Bennett et al., 2001 | I am satisfied with the financial support I receive from doing my work (JS4) | ||
Phase I findings and adapted from Mbindyo et al., 2009, Prytherch et al., 2012, Mutale et al., 2013, Penn-Kekana et al., 2005, Brunie et al., 2014, Bennett et al., 2001 | I am satisfied with the support I receive from my supervisor (JS5) | ||
Community commitment | Phase I findings | I am proud to be working for my community (CC1) | None of the motivation scales identified during phase II incorporated a community commitment factor. The inclusion of this factor is therefore based on the findings from phase I only, borrowing from the language used in items measuring organisational commitment. |
My community inspires me to do the very best I can for them (CC2) | Brunie et al. (2014) do allude to the community as an important factor, but all item statements are combined with a remuneration component (i.e. ‘I enjoy working in my community, even if it is without pay’; ‘I do not think it makes good sense for me to spend any time working in my community without payment’). | ||
Intrinsic job satisfaction | (Mbindyo et al., 2009, Mutale et al., 2013, Penn-Kekana et al., 2005, Brunie et al., 2014, Prytherch et al., 2012, Bennett et al., 2001) | Overall, I am very satisfied with my job as a CTC provider (JS6) | The term ‘CTC provider’ was replaced in each country with the context-appropriate term (i.e. HSAs, CHWs). |
(Mbindyo et al., 2009, Mutale et al., 2013, Bennett et al., 2001) | I am satisfied with the opportunities I have to use my abilities in my work (JS7) | ||
Phase I findings and adapted from Mbindyo et al., 2009, Mutale et al., 2013, Prytherch et al., 2012, Bennett et al., 2001 | I am satisfied that I accomplish something worthwhile with my work (JS8) | ||
(Mbindyo et al., 2009, Mutale et al., 2013) | I think that my work as a CTC provider is not valuable these days (JS9) | Adapted from negatively worded item ‘I do not think that my work in this health facility is valuable these days’. | |
Phase I findings | I am satisfied with the positive impact of my work (JS10) | ||
Work conscientiousness | (Mbindyo et al., 2009, Mutale et al., 2013, Bennett et al., 2001) | I can be relied upon at work (WC1) | Adapted from ‘I am reliable and dependable at work’. |
(Mbindyo et al., 2009, Mutale et al., 2013, Bennett et al., 2001) | I always complete my tasks efficiently and correctly (WC2) | ||
(Mbindyo et al., 2009, Mutale et al., 2013, Bennett et al., 2001) | I take initiative to do things without being asked or told (WC3) | Adapted from ‘I do things that need doing without being asked or told’. | |
(Mbindyo et al., 2009, Mutale et al., 2013, Bennett et al., 2001) | I am a hard worker (WC4) | ||
General motivation | (Bennett et al., 2001), adapted for/used in Mbindyo et al., 2009, Prytherch et al., 2012, Mutale et al., 2013, Penn-Kekana et al., 2005 | These days I feel motivated to work as hard as I can (MOT1) | |
(Morrison et al., 2015) | I feel I am the right person to do this job (MOT2) | Adapted from ‘I am confident in my ability to do my job’. | |
Burnout | (Mbindyo et al., 2009, Mutale et al., 2013, Penn-Kekana et al., 2005) | When I get up in the morning I don’t feel like going to work (BO1) | Adapted from ‘Sometimes when I get up in the morning, I dread having to face another day at work’. |
(Mbindyo et al., 2009, Mutale et al., 2013, Penn-Kekana et al., 2005) | I feel emotionally tired at the end of the day (BO2) | ||
I feel physically tired at the end of the day (BO3) | Added as connected to BO2. |
Phase III—Tool refinement and structure validation
Factor | Organisational commitment | Job satisfaction | Community commitment | Conscientiousness |
---|---|---|---|---|
Organisational commitment | 1.00 | |||
Job satisfaction | 0.73 | 1.00 | ||
Community commitment | 0.74 | 0.87 | 1.00 | |
Conscientiousness | 0.57 | 0.77 | 0.75 | 1.00 |
Item | β | B | SE |
---|---|---|---|
Satisfaction | |||
I am satisfied that I accomplish something worthwhile with my work. | .53 | 1.00 | – |
I am satisfied with the positive impact of my work. | .62 | 1.09 | .15 |
I am satisfied with the support I receive from my colleagues. | .63 | 1.03 | .16 |
I am satisfied with the community thanks and recognition I receive for my work. | .72 | 1.40 | .17 |
Organisational commitment | |||
I am proud to be working for my organisation as a CTC provider. | .78 | 1.00 | – |
My organisation really inspires me to do the very best on the job. | .39 | .65 | .14 |
Community commitment | |||
I am proud to be working for my community. | .73 | 1.00 | – |
My community inspires me to do the very best I can for them. | .58 | 1.04 | .13 |
Work conscientiousness | |||
I can be relied upon at work. | .80 | 1.00 | – |
I always complete my tasks efficiently and correctly. | .71 | .78 | .08 |
I take initiatives to do things without being asked or told. | .69 | .81 | .07 |
I am a hard worker. | .73 | .84 | .08 |
Factor | Organisational commitment | Job satisfaction | Community commitment | Conscientiousness |
---|---|---|---|---|
Organisational commitment | 1.00 | |||
Job satisfaction | 0.68 | 1.00 | ||
Community commitment | 0.52 | 0.92 | 1.00 | |
Conscientiousness | 0.53 | 0.76 | 0.66 | 1.00 |
Item | β | B | SE |
---|---|---|---|
Satisfaction | |||
I am satisfied that I accomplish something worthwhile with my work. | .63 | 1.00 | – |
I am satisfied with the positive impact of my work. | .68 | 1.21 | .17 |
I am satisfied with the support I receive from my colleagues. | .51 | 0.93 | .17 |
I am satisfied with the community thanks and recognition I receive for my work. | .68 | 1.19 | .18 |
Organisational commitment | |||
I am proud to be working for my organisation as a CTC provider. | .91 | 1.00 | – |
My organisation really inspires me to do the very best on the job. | .27 | .42 | .16 |
Community commitment | |||
I am proud to be working for my community. | .85 | 1.00 | – |
My community inspires me to do the very best I can for them. | .59 | .95 | .11 |
Work conscientiousness | |||
I can be relied upon at work. | .71 | 1.00 | – |
I always complete my tasks efficiently and correctly. | .68 | .88 | .09 |
I take initiatives to do things without being asked or told. | .72 | .95 | .12 |
I am a hard worker. | .76 | 1.04 | .09 |