Abstract:
Background The continued success of community case management
(CCM) programs in low-resource settings depends on the ability of
these programs to retain the community health workers (CHWs), many
of whom are volunteers, and maintain their high-quality performance.
This study aims to identify factors related to the motivation and satis-
faction of CHWs working in a malaria CCM program in two sub-coun-
ties in Western Kenya.
Methods We interviewed 70 CHWs who were trained to administer
malaria rapid diagnostic tests as part of a broader study evaluating a
malaria CCM program. We identified factors related to CHWs’ moti-
vation and their satisfaction with participation in the program, as well
as the feasibility of program scale-up. We used principal components
analysis to develop an overall CHW satisfaction score and assessed as-
sociations between this score and individual CHW characteristics as
well as their experiences in the program.
Results The majority of CHWs reported that they were motivated to
perform their role in this malaria CCM program by a personal desire to
help their community (69%). The most common challenge CHWs re-
ported was a lack of community understanding about malaria diagnostic
testing and CHWs’ role in the program (39%). Most CHWs (89%) re-
ported that their involvement in the diagnostic testing intervention had
either a neutral or a net positive effect on their other CHW activities, in-
cluding improving skills applicable to other tasks. CHWs who said they
strongly agreed with the statement that their work with the malaria pro-
gram was appreciated by the community had a 0.76 standard deviation
(SD) increase in their overall satisfaction score (95% confidence interval
CI = 0.10-1.24, P = 0.03). Almost all CHWs (99%) strongly agreed that
they wanted to continue their role in the malaria program.
Conclusions Overall, CHWs reported high satisfaction with their role
in community-based malaria diagnosis, though they faced challenges
primarily related to community understanding and appreciation of the
services they provided. CHWs’ perceptions that the malaria program
generally did not interfere with their other activities is encouraging for
the sustainability and scale-up of similar CHW programs.
