Transcript Mobilizing CHW Internal Motivation to Improve Program Sustainability By Paul Freeman Clinical Assistant Professor Dept Global Health University of Washington Contact.

Mobilizing CHW Internal Motivation to Improve Program Sustainability
By Paul Freeman Clinical Assistant Professor Dept Global Health University of Washington Contact [email protected]
The Problem
Large Populations in
developing countries with
limited access to health
care for many reasons
World Urbanization Prospects, the 2009
Revision Urban and rural population by
development regions (in millions)
Example of Intrinsic Motivation use
Motivation after Pink’s “Drive”
Three Basic Human Drives:
Biological: Hunger, thirst and copulation
Extrinsic reward: Reward and punishment
delivered by the environment for behaving in
certain ways (Carrot & Stick)---commonly used
Intrinsic reward: The joy/satisfaction of
completing a task motivates its completion.
Care Groups
Use of Care Groups is a community-based strategy for
improving coverage and behavior change. Now used
in 22 countries. Often begins with NGO but later
becomes independent part of national program. (EG
most recently in Rwanda)
FH/Mozambique Care Group Model
Each Health Promoter
educates and motivates 5 Care
Groups. Each Care Group has
12 Care Group Volunteers
(a.k.a., Leader Mothers)
Promoters
Limitations of Extrinsic Reward
Good for unrelenting, routine, mechanical, or
(Paid CHWs)
Care
Groups
Promoter #2
12 Leader Mothers
Promoter #1
Source: United Nations, Department of Economic and
Social Affairs,2010
boring tasks but not for quality & commitment
can: crush creativity, encourage cheating,
shortcuts, unethical behavior, foster short-term
We now have good evidence
that many common health
problems can be addressed
by CHW’s in community but
how can we motivate, retain
and get them to practice well
at affordable cost?
Intrinsic Reward: current psyche says best
Give people (e.g., CHWs) Autonomy … of
task (what they do), time (when they do it),
team (who they do it with) and technique (how
they do it). (Except clinical treatment detail)
Helping people to achieve Mastery.
Helping people to discover Purpose on their
terms e.g. self image, help family, community
Modern technology will help
but ??? Cost for billions of
people living on <$2/day,
?motivation to use correctly
? maintenance
For all CHWs can focus on intrinsic reward &
need to provide basic training, supplies,
consumables and supervision but only pay
for those working many hours (> 8 per week)
with advanced skills
Promoter #3
12 Leader Mothers
12 Leader Mothers
Promoter #5
Promoter #4
Promoter #6
12 Leader Mothers
12 Leader Mothers
Promoter #7
Each Care Group Volunteer
educates and motivates
pregnant women and mothers
with children 0-23m of age in 12
households every two weeks.
Children in households with
children 24-59m are visited every
six months.
12 families
12 families
12 families
12 families
12 families
12 families
12 families
12 families
12 families
12 families
12 families
12 families
With this model, one Health Promoter can cover 720 beneficiary households.
Only Promoter is paid
Evaluation of above Mozambique project
30% reduction in child mortality at $442 per life
saved by 65 paid CHWs & 4,100 Care Group
Volunteers for 1.1M people. Good retention of
workers (93%), maintenance of EPI coverage and
ORS usage for diarrhea, on 4 year follow up post
5 yr long project. P.S. Also Social Capital building
D.H. Pink Drive: The Surprising Truth About What Motivates Us” Riverhead Books Pubs Penguin Books New York 2011