Factors influencing job satisfaction of CHWs in Bangladesh

 

Community Health Workers (CHWs) play a crucial role in countries like Pakistan (43%), India (46%), and Bangladesh (42%) in promoting health, preventing diseases, providing curative care, and offering referral services at the primary healthcare (PHC) level, especially in remote areas. Bangladesh’s health system is supported by about 3.8 CHWs per 10,000 people across public, private, and NGO sectors who are the primary point of contact with the health system and the backbone of Bangladesh's PHC system. Frequently, these CHWs are overloaded with various programme activities and need incentives and remuneration for motivation. To strengthen the PHC system in Bangladesh, understanding these motivators that determine CHW job satisfaction is essential for optimum performance and retention over time.

A cross-sectional convergent parallel mixed-method study collected census data from four sub-districts (upazila) from four corners of the country (Sulla, Tetulia, Chowgacha and Teknaf), This was supplemented by in-depth interviews (IDIs), Key Informant Interviews (KIIs), and Focus Group Discussions (FGDs) with CHWs, their supervisors and relevant key stakeholders . CHWs came from the public, private, and NGO sectors and the study explored their job satisfaction factors.

More than one-third of CHWs reported job satisfaction (35%). The divorced, widowed, or separated CHWs had significantly higher job satisfaction compared to single CHWs. CHWs whose household head was a homemaker also had higher job satisfaction compared to those with an agricultural day laborer as the household head. Job satisfaction determinants comprised of financial incentives, non-financial incentives, health system factors, and community-level factors.

Timely, regular, and adequate remuneration, including periodic increments and service-related allowances, was crucial for job satisfaction. Unlike previous studies, participation in training was not significantly associated with CHW satisfaction. However, refresher training, career development opportunities, and non-monetary incentives (see below) contributed to job satisfaction. Health system factors like permanent jobs, adequate supplies, manageable workloads, supportive supervision, and individual performance tracking were critical. Community-driven initiatives also significantly contributed to CHW satisfaction, highlighting the importance of community ownership and support.

The findings indicate the need for integrating financial and non-financial incentives with health system and community-level factors to maintain a satisfied and motivated CHW workforce. This integration is essential for building a resilient and sustainable health workforce capable of delivering optimum healthcare services at the grassroots level.

From a recently completed study on CHW performance and job satisfaction