Hope and despair: community health assistants’ experiences of working in a rural district in Zambia

Human Resources for Health

Anna-Karin Hurtig²  Charles Michelo¹  John Kinsman²  Joseph Mumba Zulu² 

[1] Department of Public Health, School of Medicine, University of Zambia, P.O. Box 50110, Lusaka, Zambia;Umeå International School of Public Health (UISPH), Umeå University, Umeå SE 90185, Sweden

关键词: Zambia;    Work motivation;    Work experience;    Community-based health workers;   

Others  :  821652
DOI  :  10.1186/1478-4491-12-30

 received in 2013-12-22, accepted in 2014-04-29,  发布年份 2014

【 摘 要 】

Background

In order to address the challenges facing the community-based health workforce in Zambia, the Ministry of Health implemented the national community health assistant strategy in 2010. The strategy aims to address the challenges by creating a new group of workers called community health assistants (CHAs) and integrating them into the health system. The first group started working in August 2012. The objective of this paper is to document their motivation to become a CHA, their experiences of working in a rural district, and how these experiences affected their motivation to work.

Methods

A phenomenological approach was used to examine CHAs’ experiences. Data collected through in-depth interviews with 12 CHAs in Kapiri Mposhi district and observations were analysed using a thematic analysis approach.

Results

Personal characteristics such as previous experience and knowledge, passion to serve the community and a desire to improve skills motivated people to become CHAs. Health systems characteristics such as an inclusive work culture in some health posts motivated CHAs to work. Conversely, a non-inclusive work culture created a social structure which constrained CHAs’ ability to learn, to be innovative and to effectively conduct their duties. Further, limited supervision, misconceptions about CHA roles, poor prioritisation of CHA tasks by some supervisors, as well as non- and irregular payment of incentives also adversely affected CHAs’ ability to work effectively. In addition, negative feedback from some colleagues at the health posts affected CHA’s self-confidence and professional outlook. In the community, respect and support provided to CHAs by community members instilled a sense of recognition, appreciation and belonging in CHAs which inspired them to work. On the other hand, limited drug supplies and support from other community-based health workers due to their exclusion from the government payroll inhibited CHAs’ ability to deliver services.

Conclusions

Programmes aimed at integrating community-based health workers into health systems should adequately consider multiple incentives, effective management, supervision and support from the district. These should be tailored towards enhancing the individual, health system and community characteristics that positively impact work motivation at the local level if such programmes are to effectively contribute towards improved primary healthcare.

【 授权许可】

   
2014 Zulu et al.; licensee BioMed Central Ltd.

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