Impact of a recognition package as an incentive to strengthen the motivation, performance, and retention of village health teams in Uganda: a study protocol for a cluster randomized controlled trial

Trials

Study Protocol

Raymond Tweheyo¹  Elizeus Rutebemberwa¹  Emmanuel Obuya¹  Smisha Agarwal²  Shivani Pandya²  Meike Schleiff²  Arisa Kiyomoto²  Mario Macis³  Paloma Mitra⁴  Tanvi Nagpal⁵ 

[1] Makerere University School of Public Health, Kampala, Uganda;The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA;The Johns Hopkins University Carey School of Business, Baltimore, MD, USA;The Johns Hopkins University Krieger School of Arts & Sciences, Baltimore, MD, USA;The Johns Hopkins University School of Advanced International Studies, Foreign Policy Institute, Washington, DC, USA;

关键词: Community health workers;    Community health systems;    Incentives;    Motivation;    Performance;   

DOI  :  10.1186/s13063-023-07426-6

 received in 2022-11-30, accepted in 2023-06-02,  发布年份 2023

来源: Springer

【 摘 要 】

IntroductionUganda’s community health worker (CHW), or village health team (VHT), program faces significant challenges with poor retention and insufficient financial and program investment. Adequate compensation comprising financial and non-financial components is critical to retaining any workforce, including CHWs. This study evaluates the impact of a recognition-based non-financial incentives package on the motivation, performance, and retention of VHTs, as well as on the utilization of health services by the community. The incentive package and intervention were developed in collaboration with the district-level leadership and award VHTs who have met predetermined performance thresholds with a certificate and a government-branded jacket in a public ceremony.MethodsA two-armed cluster randomized controlled trial (RCT), conducted at the parish level in Uganda’s Masindi District, will evaluate the effects of the 12-month intervention. The cluster-RCT will use a mixed-methods approach, which includes a baseline/endline VHT survey to assess the impact of the intervention on key outcomes, with an expected sample of 240 VHTs per study arm; our primary outcome is the total number of household visits per VHT and our multiple secondary outcomes include other performance indicators, motivation, and retention; VHT performance and retention data will be validated using monthly phone surveys tracking key performance indicators and through abstraction of VHT-submitted health facility reports; and focus group discussions will be conducted with VHTs and community members to understand how the intervention was received. Data collection activities will be administered in local languages. To assess the impact of the intervention, the study will conduct a regression analysis using Generalized Estimating Equations adjusting for cluster effect. Further, a difference-in-differences analysis will be conducted.DiscussionThis study utilized a cluster-RCT design to assess the impact of a recognition-based incentives intervention on the motivation, performance, and retention of VHTs in Uganda’s Masindi District. Utilizing a mixed-methods approach, the study will provide insights on the effectiveness and limitations of the intervention, VHT perspectives on perceived value, and critical insights on how non-financial incentives might support the strengthening of the community health workforce.Trial registrationClinicalTrials.gov NCT05176106. Retrospectively registered on 4 January 2022.

【 授权许可】

CC BY   
© The Author(s) 2023

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