In countries where there are insufficient supplies of different types of formal health
workers, Community Health Workers (CHWs) can play an important role in
increasing the coverage of healthcare among the poor. BRAC, the largest NGO in
Bangladesh, is a pioneer in using female CHWs as core workers in its successful
health programmes. In 2008, BRAC initiated an intervention project called “improving
maternal, neonatal, and child health survival (IMNCS) programme in the rural areas of
northern Bangladesh. The CHWs play a significant role in implementing the
programme’s activities that are designed for improving maternal, neonatal and child
health in the rural community.
This study examined factors associated with the retention of CHWs in the IMNCS
programme. Surveys on CHWs were conducted in three IMNCS intervention districts
during May-June 2011 and in one Control district where there is Essential Health
Care (EHC) Programme in place. In total, 2790 current and 387 dropout CHWs
participated in the survey.
The desire to earn extra income to provide financial assistance to the households,
the eagerness to contribute to the improvement in community health, the opportunity
to attain social recognition in the community- these were found to be the major
factors that motivated someone to become a CHW. CHWs whose income is a
significant proportion of the total household’s expenditure were more likely to
continue their services with BRAC. The non-financial incentives such as increased
importance in society and within family, as well as satisfaction with the supervisions
were significantly associated with retention. Those who were dissatisfied with: pay
and allowances, working relationship with supervisors, workload levels, and the
amount of traveling needed to cover required number of households, are likely to
leave the job.
While the study indicates that financial incentives are the most important factor to
retain the CHWs, there are other non-financial incentives that could be strengthened
to improve their retention. However, these increased amount of financial incentives
need to be sustained by BRAC. This can be cross subsidised by BRAC’s other
health programmes implemented in those intervention areas. Keywords: Incentive,
Community Health Worker, Retention, Health system.