The Busara Blog
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The Busara Blog

What moves you?

Behavioral Science for improving community health worker performance

By Franciscah Nzanga (1), Tabitha Mberi (1), Stephen Odindo (1), Isaac Mwangi (1), Beatrice Wasunna (2) and Nengapate Kuria (3)

Illustration by Anthony Mogaka

The global movement towards Universal Health Care (UHC) is underpinned by sustainable development goal three, which champions access to quality and affordable healthcare as a vital step towards a peaceful and prosperous people and planet. The delivery of a comprehensive spectrum of health services from preventative to curative is the cornerstone of this and requires the deployment and distribution of competent health care workers to support individuals and communities.

Community health workers serve as the first point of contact by linking vulnerable populations to appropriate healthcare providers, assisting patients to navigate social and health systems. Keeping their wellbeing in mind while considering how to spur workforce transformation in community health is a challenge unique to delivering UHC; its delivery relies on a workforce that historically serves on a voluntary basis driven by altruistic motives. Literature and anecdotal evidence shows that CHWs, including those in the countries Living Goods works, are largely driven by the desire to do things that matter to their community and to be part of a mission-driven movement. As the world grapples with the COVID-19 pandemic, CHWs now face increased work and risk in their roles, which are now more essential than ever as they fill the service delivery gap. Keeping them motivated is therefore crucial for health care.

Research on motivation has come a long way. A number of recent studies with CHWs have demonstrated the role of both intrinsic and extrinsic motivation. Intrinsic factors include a sense of personal fulfillment, love for the job, and an innate desire to do well. Extrinsic motivation often represents something that can be earned, including financial rewards, supervisor recognition and praise, or access to training and professional development benefits. While intrinsic motivation is an essential part of CHW identity, small extrinsic incentives, such as community or peer recognition, availability of support, and small rewards, have a role to play in sustaining and strengthening that motivation.

Keeping this in mind, the Community Health Innovation Network (CHIN) set out to understand how best to bolster CHWs and designed various solutions to test the same. One of these solutions was the prototype badges, where the top performing CHWs received digital badges they could display on WhatsApp. The digital badge was not only expected to extrinsically motivate those who received and displayed it on WhatsApp but also encourage others to strive for similar appreciation, eventually leading to better performance and improved healthcare services.

Though the badges as incentives worked to reinforce good performance, they did not motivate better performance or create a drive to achieve them among the CHWs who did not receive the badges. All CHWs already believed themselves to be hardworking and committed. They reported high levels of intrinsic motivation, as seen by their desire to be part of the greater good and help those in the communities they work in. However, what this study shows is that over and above the need for testing before scaling design, understanding a particular group’s motivation is especially important as it will create the opportunity to develop specific impactful solutions. In this case, giving everyone a badge would not only have cemented the respect and trust between CHWs and the Innovation Network, but it would also have served as an acknowledgement of the work they do, thus motivating them further.

If you’re interested in the work that was done and want to gain a more in-depth understanding of the study, read the case study here and reach out if you have any questions.

This blog was originally posted here.

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