Inspiring health worker motivation with supportive supervision: a survey of lady health supervisor motivating factors in rural Pakistan

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Abstract

Background

Community health worker motivation is an important consideration for improving performance and addressing maternal, newborn, and child health in low and middle-income countries. Therefore, identifying health system interventions that address motivating factors in resource-strained settings is essential. This study is part of a larger implementation research project called Nigraan, which is intervening on supportive supervision in the Lady Health Worker Programme to improve community case management of pneumonia and diarrhea in rural Pakistan. This study explored the motivation of Lady Health Supervisors, a cadre of community health workers, with particular attention to their views on supportive supervision.

Methods

Twenty-nine lady health supervisors enrolled in Nigraan completed open-ended structured surveys with questions exploring factors that affect their motivation. Thematic analysis was conducted using a conceptual framework categorizing motivating factors at individual, community, and health system levels.

Results

Supportive supervision, recognition, training, logistics, and salaries are community and health system motivating factors for lady health supervisors. Lady health supervisors are motivated by both their role in providing supportive supervision to lady health workers and by the supervisory support received from their coordinators and managers. Family support, autonomy, and altruism are individual level motivating factors.

Conclusions

Health system factors, including supportive supervision, are crucial to improving lady health supervisor motivation. As health worker motivation influences their performance, evaluating the impact of health system interventions on community health worker motivation is important to improving the effectiveness of community health worker programs.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-016-1641-x) contains supplementary material, which is available to authorized users.

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Most cited references 27

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Achieving child survival goals: potential contribution of community health workers.

Andy Haines, David Sanders, Uta Lehmann … (2007)

There is renewed interest in the potential contribution of community health workers to child survival. Community health workers can undertake various tasks, including case management of childhood illnesses (eg, pneumonia, malaria, and neonatal sepsis) and delivery of preventive interventions such as immunisation, promotion of healthy behaviour, and mobilisation of communities. Several trials show substantial reductions in child mortality, particularly through case management of ill children by these types of community interventions. However, community health workers are not a panacea for weak health systems and will need focussed tasks, adequate remuneration, training, supervision, and the active involvement of the communities in which they work. The introduction of large-scale programmes for community health workers requires evaluation to document the impact on child survival and cost effectiveness and to elucidate factors associated with success and sustainability.

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Health sector reform and public sector health worker motivation: a conceptual framework.

Lynne Miller Franco, Sara Bennett, Ruth Kanfer (2002)

Motivation in the work context can be defined as an individual's degree of willingness to exert and maintain an effort towards organizational goals. Health sector performance is critically dependent on worker motivation, with service quality, efficiency, and equity, all directly mediated by workers' willingness to apply themselves to their tasks. Resource availability and worker competence are essential but not sufficient to ensure desired worker performance. While financial incentives may be important determinants of worker motivation, they alone cannot and have not resolved all worker motivation problems. Worker motivation is a complex process and crosses many disciplinary boundaries, including economics, psychology, organizational development, human resource management, and sociology. This paper discusses the many layers of influences upon health worker motivation: the internal individual-level determinants, determinants that operate at organizational (work context) level, and determinants stemming from interactions with the broader societal culture. Worker motivation will be affected by health sector reforms which potentially affect organizational culture, reporting structures, human resource management, channels of accountability, types of interactions with clients and communities, etc. The conceptual model described in this paper clarifies ways in which worker motivation is influenced and how health sector reform can positively affect worker motivation. Among others, health sector policy makers can better facilitate goal congruence (between workers and the organizations they work for) and improved worker motivation by considering the following in their design and implementation of health sector reforms: addressing multiple channels for worker motivation, recognizing the importance of communication and leadership for reforms, identifying organizational and cultural values that might facilitate or impede implementation of reforms, and understanding that reforms may have differential impacts on various cadres of health workers.

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Supervising community health workers in low-income countries – a review of impact and implementation issues

Zelee Hill, Mari Dumbaugh, Lorna Benton … (2014)

Background Community health workers (CHWs) are an increasingly important component of health systems and programs. Despite the recognized role of supervision in ensuring CHWs are effective, supervision is often weak and under-supported. Little is known about what constitutes adequate supervision and how different supervision strategies influence performance, motivation, and retention. Objective To determine the impact of supervision strategies used in low- and middle-income countries and discuss implementation and feasibility issues with a focus on CHWs. Design A search of peer-reviewed, English language articles evaluating health provider supervision strategies was conducted through November 2013. Included articles evaluated the impact of supervision in low- or middle-income countries using a controlled, pre-/post- or observational design. Implementation and feasibility literature included both peer-reviewed and gray literature. Results A total of 22 impact papers were identified. Papers were from a range of low- and middle-income countries addressing the supervision of a variety of health care providers. We classified interventions as testing supervision frequency, the supportive/facilitative supervision package, supervision mode (peer, group, and community), tools (self-assessment and checklists), focus (quality assurance/problem solving), and training. Outcomes included coverage, performance, and perception of quality but were not uniform across studies. Evidence suggests that improving supervision quality has a greater impact than increasing frequency of supervision alone. Supportive supervision packages, community monitoring, and quality improvement/problem-solving approaches show the most promise; however, evaluation of all strategies was weak. Conclusion Few supervision strategies have been rigorously tested and data on CHW supervision is particularly sparse. This review highlights the diversity of supervision approaches that policy makers have to choose from and, while choices should be context specific, our findings suggest that high-quality supervision that focuses on supportive approaches, community monitoring, and/or quality assurance/problem solving may be most effective.

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Author and article information

Contributors

Fauziah Rabbani: fauziah.rabbani@aku.edu

Leah Shipton:

ORCID: http://orcid.org/0000-0002-6105-4091

leahshipton@icloud.com

Wafa Aftab: wafa.aftab@aku.edu

Kashif Sangrasi: kashif.sangrasi@aku.edu

Shagufta Perveen: shagufta.perveen@aku.edu

Aysha Zahidie: aysha.zahidie@aku.edu

Journal

Journal ID (nlm-ta): BMC Health Serv Res

Journal ID (iso-abbrev): BMC Health Serv Res

Title: BMC Health Services Research

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6963

Publication date (Electronic): 17 August 2016

Publication date PMC-release: 17 August 2016

Publication date Collection: 2016

Volume: 16

Electronic Location Identifier: 397

Affiliations

Department of Community Health Sciences, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74 800 Pakistan

Author information

Leah Shipton http://orcid.org/0000-0002-6105-4091

Article

Publisher ID: 1641

DOI: 10.1186/s12913-016-1641-x

PMC ID: 4989332

PubMed ID: 27535743

SO-VID: 4fe8e0df-df48-44c6-9926-f7c415d20366

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 1 August 2015

Date accepted : 6 August 2016

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100004423, World Health Organization (CH);

Award ID: MCA00113

Award Recipient : Fauziah Rabbani

Custom metadata

ScienceOpen disciplines: Health & Social care

Keywords: community health worker,motivation,supportive supervision,health system,implementation research,lady health supervisor,lady health worker,pakistan

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ScienceOpen disciplines: Health & Social care

Keywords: community health worker, motivation, supportive supervision, health system, implementation research, lady health supervisor, lady health worker, pakistan

Inspiring health worker motivation with supportive supervision: a survey of lady health supervisor motivating factors in rural Pakistan

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Most cited references 27

Achieving child survival goals: potential contribution of community health workers.

Health sector reform and public sector health worker motivation: a conceptual framework.

Supervising community health workers in low-income countries – a review of impact and implementation issues

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