Non-financial Incentives on Motivation of Community Health Promoters for Provision of Community Health Services in Taita Taveta County, Kenya

Authors

  • Moses Ndegwa Mwanyoha PhD Student, Department of Health Systems Management, Kenya Methodist University, Nairobi, Kenya.
  • Kezia Njoroge Department of Health Systems Management, Kenya Methodist University, Nairobi, Kenya.
  • Eunice Nyavanga Department of Human Nutrition & Dietetics, Kenya Methodist University, Nairobi, Kenya.

DOI:

https://doi.org/10.58425/jphs.v4i1.363

Keywords:

Community health promoters, community health, non-financial incentives, motivation

Abstract

Aim: The aim of the study was to develop a non-financial incentives model which is culturally acceptable, feasible and sustainable on motivation of community health promoters for the provision of community health services in Taita Taveta County.

Methods: The study adopted a cross-sectional design conducted in Voi sub-county, Taita Taveta County. The primary target population were community health promoters, while secondary target population were county and sub-county health management team members. Data collection tools used were researcher-administered questionnaires and key informant interviews. Qualitative and quantitative data was collected for this study. Quantitative data was analyzed using SPSS version 26, results then summarized, and presented in frequency tables, figures and charts. Qualitative data was first analyzed thematically using content analysis by categorizing it into various themes, and the responses coded and classified into the various categories.

Results: The study found significant improvements in provision of work identification materials such as protective gear, medications, monitoring health tools, health educational materials, and growth monitoring tools (z-score =5.567, p ≤ 0.000). Significant improvements were also observed in community appreciation, advocacy, safety guarantees, gratitude expressions, family support, and recognition (z-score=3.526, p ≤ 0.000). Significant improvements were also observed in self-help group membership, reduced cost of trading licenses, access to government procurement opportunities, participation in expos/trade fairs, and access to markets (z-score= -4.669, p ≤ 0.001).

Conclusion: The study concludes that CHPs’ have got high expectations of gaining career experience and belief in career growth opportunities with high satisfaction levels in key areas such as training, mentorship, supervision, peer engagement and opportunities for additional responsibilities. 

Recommendations: The study recommends that the department of health to enhance non-financial incentives that support professional growth and have clear and transparent pathways to permanent employment.

References

Abuya, T., Mwanga, D., Obadha, M., Ndwiga, C., Odwe, G., Kavoo, D., Wanyugu, J., Warren, C., & Agarwal, S. (2021). Incentive preferences for community health volunteers in Kenya: findings from a discrete choice experiment. BMJ open, 11(7), e048059. https://doi.org/10.1136/bmjopen-2020-048059

Agarwal, S., Anaba, U., Abuya, T., et al Kintu, R., Casseus, A., Hossain, S. Obadha, M., & Warren, C. E. (2019). Understanding incentive preferences of community health workers using discrete choice experiments: a multi-country protocol for Kenya, Uganda, Bangladesh and Haiti. BMJ Open, 9, e033601. https://doi.org/10.1136/bmjopen-2019-033601

Agarwal, S., Tamrat, T., Fønhus, M. S., Henschke, N., Bergman, H., Mehl, G. L., Glenton, C., & Lewin, S. (2018). Tracking health commodity inventory and notifying stock levels via mobile devices. The Cochrane Database of Systematic Reviews, 2018(1), CD012907. https://doi.org/10.1002/14651858.CD012907

Ajisegiri, W. S., Peiris, D., Abimbola, S., Odusanya, O. O., Tesema, A. G., Joshi, R., & Angell, B. (2022). It is not all about salary: a discrete-choice experiment to determine community health workers’ motivation for work in Nigeria. BMJ Global Health, 7(10), e009718. https://doi.org/10.1136/bmjgh-2022-009718

Amare, Y. (2009). Non-financial incentives for volunteer community health workers: A qualitative study (Working Paper No. 1). The Ten Kilometres Project, JSI Research & Training Institute, Inc.

Ankomah, S. E., Kumah, E., & Kusiwaa-Karikari, A. (2016). Health Worker Motivation in Ghana: The Role of Non-Financial Incentives. A Case Study of Accident and Emergency Department of Komfo Anokye Teaching Hospital. International Journal of Biosciences, Healthcare Technology and Management, 6(4), 34–49. https://doi.org/10.5281/zenodo.1421931

Bhattacharyya, K., Winch, P., LeBan, K., Tien, M. (2001). Community health worker incentives and disincentives: how they affect motivation, retention and sustainability. Arlington, Virginia: BASICS/USAID.

Bhutta, A. Z., Lassi, Z. S., Pariyo, G., Huicho, L. (2010). Global Experience of Community Health Workers for Delivery of Health Related Millennium Development Goals: A Systematic Review, Country Case Studies, and Recommendations for Integration into National Health Systems. Geneva: World Health Organization.

Brunie, A., Wamala-Mucheri, P., Otterness, C., Akol, A., Chen, M., Bufumbo, L., & Weaver, M. (2014). Keeping community health workers in Uganda motivated: key challenges, facilitators, and preferred program inputs. Global health, science and practice, 2(1), 103–116. https://doi.org/10.9745/GHSP-D-13-00140

Colvin, C. J., Hodgins, S., & Perry, H. B. (2021). Community health workers at the dawn of a new era: 8. Incentives and remuneration. Health Research Policy and Systems, 19(Suppl 3), 106. https://doi.org/10.1186/s12961-021-00750-w

Crigler, L., Gergen, J., Perry, H. (2014). Supervision of Community Health Workers. In H. Perry, & L. Crigler (Eds.), Developing and Strengthening Community Health Worker Programs at Scale: A Reference Guide and Case Studies for Program Managers and Policy Makers. Washington, DC: USAID/MCHIP. https://coregroup.org/wp-content/uploads/2017/08/CHW-Reference-Guide-Chapter-10-Supervision-of-Community-Health-Workers.pdf

Cronbach, L. (1951). Coefficient alpha and the international structure of tests. Psychomerika, 16(1), 297-334. https://doi.org/10.1007/BF02310555

Dagne, T., Beyene, W., & Berhanu, N. (2015). Motivation and Factors Affecting It among Health Professionals in the Public Hospitals, Central Ethiopia. Ethiopian journal of health sciences, 25(3), 231–242. https://doi.org/10.4314/ejhs.v25i3.6

Datiko, D. G., Yassin, M. A., Theobald, S. J., Blok, L., Suvanand, S., Creswell, J., & Cuevas, L. E. (2017). Health extension workers improve tuberculosis case finding and treatment outcome in Ethiopia: a large-scale implementation study. BMJ global health, 2(4), e000390. https://doi.org/10.1136/bmjgh-2017-000390

Dynes, M., Stephenson, R., Rubardt, M., & Bartel, D. (2012). The influence of perceptions of community norms on current contraceptive use among men and women in Ethiopia and Kenya. Health & Place, 18(4), 766–773. https://doi.org/10.1016/j.healthplace.2012.04.006

Golafshani, N. (2003). Understanding Reliability and Validity in Qualitative Research. The Qualitative Report, 8(4), 597-606. https://doi.org/10.46743/2160-3715/2003.1870

Jigssa, H.A., Desta, B.F., Tilahun, H.A., McCutcheon, J., & Berman, P. (2018). Factors contributing to motivation of volunteer community health workers in Ethiopia: the case of four woredas (districts) in Oromia and Tigray regions. Human Resources for Health, 16(1), 57. https://doi.org/10.1186/s12960-018-0319-3

Kenya National Bureau of Statistics, Kenya. (2019). 2019 Kenya Population and Housing Census: Volume 1 - Population by County and Sub-County. Kenya National Bureau of Statistics. https://www.knbs.or.ke/download/2019-kenya-population-and-housing-census-volume-i-population-by-county-and-sub-county/?wpdmdl=5615&refresh=642024bc4619e1679828156

Kenya Red Cross Society and British Red Cross. (2021). An Evaluation Report of the Taita Taveta Cash for Health in Emergencies Project. Kenya Red Cross Society. https://cash-hub.org/wp-content/uploads/sites/3/2021/07/Evaluation-Report-Cash-for-Health-in-Emergencies-Taita-Taveta-Kenya-FINAL.pdf

Kithuka, P. M. (2016). Predictors of community health volunteers’ retention in service in Makueni county, Kenya [Unpublished doctoral dissertation]. Kenyatta University. https://ir-library.ku.ac.ke/bitstream/handle/123456789/10617/Predictors%20of%20community%20%20health.....pdf?isAllowed=y&sequence=4

Kok, M., Abdella, D., Mwangi, R., Ntinginya, M., Rood, E., Gassner, J., Church, K., & Wheatley, N. (2019). Getting more than "claps": incentive preferences of voluntary community-based mobilizers in Tanzania. Human Resources for Health, 17(1), 101. https://doi.org/10.1186/s12960-019-0438-5

Kothari C.R., & Gaurav, G. (2014). Research methodology: methods and techniques (3rd ed.). New Age International (P) Limited.

Lehmann, U., Sanders, D. (2007). Community Health Workers; what do we know about them? The state of the evidence on programs, activities, costs and impact on health outcomes of using community health workers. Geneva. World Health Organization

Lohmann, J., Souares, A., Tiendrebeogo, J., Houlfort, N., Robyn, P. J., Somda, S. M. A., De Allegri, M. (2017). Measuring health workers’ motivation composition: validation of a scale based on Self-Determination Theory in Burkina Faso. Human Resources for Health, 15(1), 1478-4491. https://doi.org/10.1186/s12960-017-0208-1

Lusambili, A.M., Nyanja, N., Chabeda, S.V., Temmerman, M., Nyaga, L., Obure, J., & Ngugi, A.K. (2021). Community health volunteers challenges and preferred income generating activities for sustainability: a qualitative case study of rural Kilifi, Kenya. BMC Health Serv Res, 21, 642. https://doi.org/10.1186/s12913-021-06693-w

Mbuba, M., Rugendo, C. (2012). Factors influencing motivation of voluntary community health workers implementing the community health strategy: a case of Mbeere South District, Kenya [Unpublished master’s thesis). University of Nairobi. http://erepository.uonbi.ac.ke/handle/11295/9243

Mbugua, R., Oyore, J.P., & Mwitari, J. (2017). Role of Monetary Incentives on Motivation and Retention of Community Health Workers: An Experience in a Kenyan Community. Kenyan Journal of Nursing & Midwifery, 2(2), 170-181. http://article.sapub.org/10.5923.j.phr.20180801.01.html

McLeod, S. A. (2022). Maslow’s hierarchy of needs. Simply Psychology, 1. www.simplypsychology.org/maslow.html

Ministry of Health, Kenya. (2020). Kenya Community Health Policy 2020-2030. Ministry of Health. https://www.health.go.ke/wp-content/uploads/2020/07/Kenya-Community-Health-Policy-Signed.pdf

Ministry of Health, Kenya. (2020). Kenya Community Health Strategy 2020-2025. Ministry of Health. https://www.health.go.ke/wp-content/uploads/2021/01/Kenya-Community-Health-Strategy-Final-Signed-off_2020-25.pdf

Ministry of Health, Uganda. (2015). National village health teams (VHT) Assessment in Uganda. Ministry of Health. http://library.health.go.ug/sites/default/files/resources/National%20VHT%20Assessment%20in%20Uganda%20Report%202015.pdf

Ministry of National Treasury & Planning, Kenya. (2022). Budget statement FY 2022/2023. Ministry of National Treasury & Planning. https://www.treasury.go.ke/wp-content/uploads/2021/06/Budget-Statement-for-the-FY-2022-23_F.pdf

Mugenda, O. N., & Mugenda, A. G. (2013). Research methods: A quantitave and qualitative approach. Nairobi: ACTS press.

Munywoki, C., Abdullahi, O., Abubakar, A. (2021). Factors influencing performance of community health workers as providers of basic healthcare in Ganze sub-County, Kilifi County, Kenya [Unpublished master’s thesis]. https://elibrary.pu.ac.ke/bitstream/handle/123456789/948/CATHERINE%20NDUKU%20MUNYWOKI%20.pdf?sequence=1&isAllowed=y

Nyongesa, M. B., Onyango, R. O., & Kakai, R. (2020). The Role of Income Generating Activities in Sustainable Retention of Community Health Volunteers in Primary Health-Care Service Provision in Bungoma County, Kenya. Annals of Community Health, 8(2), 1-12. https://www.academia.edu/64509744

Ogutu, M., Muraya, K., Mockler, D., & Darker, C. (2021). Factors influencing the performance of community health volunteers working within urban informal settlements in low- and middle-income countries: a qualitative meta-synthesis review. Human Resources for Health, 19(1), 144. https://doi.org/10.1186/s12960-021-00691-z

Oliver, M., Geniets, A., Winters, N., Rega, I., & Mbae, S. M. (2015). What do community health workers have to say about their work, and how can this inform improved programme design? A case study with CHWs within Kenya. Global health action, 8(1), 1-17. 27168. https://doi.org/10.3402/gha.v8.27168

Ormel, H., Kok, M.C., Kane, S., Ahmed, R., Chikaphupha, K.R., Rashid, S.F., Gemechu, D., Otiso, L., Sidat, M., Theobald, S., Taegtmeyer, M., & de Koning, K.A. (2019). Salaried and voluntary community health workers: exploring how incentives and expectation gaps influence motivation. Human Resources for Health, 17(1), 59. https://doi.org/10.1186/s12960-019-0387-z

Perry, B. (2021). Health for the people: National Community Health Worker Programs from Afghanistanto Zimbabwe. Washington, D.C.: USAID

Pink, D. H. (2009). Drive: the surprising truth about what motivates us. New York: Riverhead Books.

Ryan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist, 55(1), 68–78. https://doi.org/10.1037/0003-066X.55.1.68

Saran, I., Winn, L., Kirui, J. K., Menya, D., & O’Meara, W. P. (2020). The relative importance of material and non-material incentives for community health workers: Evidence from a discrete choice experiment in Western Kenya. Social Science & Medicine, 246, 112726. https://doi.org/10.1016/j.socscimed.2019.112726.

Sarma, H., Jabeen, I., Luies, S. K., Uddin, M. F., Ahmed, T., Bossert, T. J., & Banwell, C. (2020). Performance of volunteer community health workers in implementing home-fortification interventions in Bangladesh: A qualitative investigation. PloS one, 15(4), e0230709. https://doi.org/10.1371/journal.pone.0230709

Singh, D., Negin, J., Otim, M., Garimoi, O., Cumming, R. (2015). The effect of payment and incentives on motivation and focus of community health workers: five case studies from low-and middle-income countries. Human Resources for Health, 13(1), 58. https://doi.org/10.1186/s12960-015-0051-1

Taita Taveta County Government, (2020). Taita Taveta CPSB Strategic Plan, 2020/21 – 2024/25. 24 March 2023. https://cpsb.taitataveta.go.ke/ova_doc/taita-taveta-cpsb-strategic-plan-2020-2021-2024-2025/

Tripathy, J. P., Goel, S., & Kumar, A. M. (2016). Measuring and understanding motivation among community health workers in rural health facilities in India-a mixed method study. BioMed Central Health Services Research, 16(a), 366. https://doi.org/10.1186/s12913-016-1614-0

Tulenko, K., Møgedal, S., Afzal, M. M., Frymus, D., Oshin, A., Pate, M., Quain, E., Pinel, A., Wynd, S., & Zodpey, S. (2013). Community health workers for universal health-care coverage: from fragmentation to synergy. Bulletin of the World Health Organization, 91(11), 847–852. https://doi.org/10.2471/BLT.13.118745

UNICEF. (2010). Implementing Community Health Strategy in Kenya; an evaluation report. Division of Community Health Services, UNICEF. http://guidelines.health.go.ke:8000/media/Evaluation_Report_of_the_Community_Health_Strategy_Implementation_in_Kenya.pdf

University of Nairobi. (2021). Budgeting: Kenya’s Ticking Recurrent Expenditure Bomb. Retrieved from https://finance.uonbi.ac.ke/latest-news/budgeting-kenyas-ticking-recurrent-expenditure-bomb

Vallières, F., Kok, M., Mahmud, I., Sarker, M., Jeacocke, P., Karuga, R., Limato, L., Kea, A. Z., Chikaphupha, K., Sidat, M., Gilmore, B., & Taegtmeyer, M. (2020). Measuring motivation among close-to-community health workers: developing the CTC Provider Motivational Indicator Scale across six countries. Human Resources for Health, 18(1), 54. https://doi.org/10.1186/s12960-020-00495-7

Vareilles, G., Marchal, B., Kane, S., Petrič, T., Pictet, G., & Pommier, J. (2015). Understanding the motivation and performance of community health volunteers involved in the delivery of health programmes in Kampala, Uganda: a realist evaluation. BMJ open, 5(11), e008614. https://doi.org/10.1136/bmjopen-2015-008614

World Health Organization, United Nations Children’s Fund, United Nations Population Fund, & World Bank (2014). Trends in maternal mortality: 1990 to 2013. Geneva: World Health Organization

World Health Organization. (2018). Guideline on health policy and system support to optimize community health worker programmes. Geneva: World Health Organization.

Downloads

Published

2025-06-06

How to Cite

Mwanyoha, M. N., Njoroge, K., & Nyavanga, E. (2025). Non-financial Incentives on Motivation of Community Health Promoters for Provision of Community Health Services in Taita Taveta County, Kenya. Journal of Public Health Studies, 4(1), 1–25. https://doi.org/10.58425/jphs.v4i1.363