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Retention of female volunteer community health workers in Dhaka urban slums: a case-control study
Journal article   Peer reviewed

Retention of female volunteer community health workers in Dhaka urban slums: a case-control study

Khurshid Alam, Sakiba Tasneem and Elizabeth Oliveras
Health policy and planning, Vol.27(6), pp.477-486
2012
DOI: https://doi.org/10.1093/heapol/czr059
PMID: 21900361
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Published (Version of Record)

Abstract

Volunteer community health workers retention financial incentives non-financial incentives urban slum community health workers income community
Introduction Volunteer community health workers (CHWs) are one approach to addressing the health workforce shortage in developing countries. BRAC, a large NGO in Bangladesh, is a pioneer in using female volunteer CHWs as core workers in its successful health programmes. After 25 years of implementing the CHW model in rural areas, BRAC is now using CHWs in urban slums of Dhaka through Manoshi, a community-based maternal and child health project. However, high dropout rates among CHWs in the slums suggested a need to better understand factors associated with their retention, and consequently recommend strategies for increasing their retention. Methods This mixed-method study included a case-control design to assess factors relating to the retention of volunteer CHWs, and focus group discussions (FGDs) to explore solutions to problems. In total, 542 current and 146 dropout CHWs participated in the survey. Six FGDs were held with groups of current and groups of dropout CHWs. Results Financial incentives were the main factor linked to CHW retention. CHWs who joined with the expectation of income were almost twice as likely to remain as CHWs. This finding was reinforced by the inverse association between wealth quintile of the CHWs and retention; the poorest CHWs were significantly more likely to stay in the programme than the richest. However, social prestige, community approval and household responsibilities were important non-financial factors associated with CHW retention. Restructuring and expansion of existing financial incentives to better compensate CHWs were recommended by CHWs to improve their retention. Conclusions Factors found to be important in this study are similar to those from earlier studies in rural areas. While the data indicate that financial incentives are the most commonly discussed factor regarding CHW retention in urban slums, the results also suggest other avenues that could be strengthened to improve their retention.

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UN Sustainable Development Goals (SDGs)

This output has contributed to the advancement of the following goals:

#3 Good Health and Well-Being
#5 Gender Equality

Source: InCites

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13 Record Views
58 Times Cited - Web of Science

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Collaboration types
Domestic collaboration
International collaboration
Citation topics
1 Clinical & Life Sciences
1.156 Healthcare Policy
1.156.381 Maternal Health Equity
Web Of Science research areas
Health Care Sciences & Services
Health Policy & Services
ESI research areas
Social Sciences, general
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