Sakiba Tasneem
http://hdl.handle.net/10361/6650
2024-03-28T13:10:55Z
2024-03-28T13:10:55Z
Retention of female volunteer community health workers in Dhaka urban slums: a case-control study
Alam, Khurshid
Tasneem, Sakiba
Oliveras, Elizabeth
http://hdl.handle.net/10361/6691
2016-11-23T10:47:50Z
Retention of female volunteer community health workers in Dhaka urban slums: a case-control study
Alam, Khurshid; Tasneem, Sakiba; Oliveras, Elizabeth
Alam, K., Tasneem, S., & Oliveras, E. (2012). Retention of female volunteer community health workers in dhaka urban slums: A case-control study. Health Policy and Planning, 27(6), 477-486. doi:10.1093/heapol/czr059; 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.
This article was published in The Journal of Health Policy and Planning [©2012 Published by Oxford Journal] and the definite version is available at: http://doi.org/10.1093/heapol/czr059 The Article's website is at: http://heapol.oxfordjournals.org/content/27/6/477
Reservation wage of female volunteer community health workers in Dhaka urban slums: a bidding game approach
Alam, Khurshid
Tasneem, Sakiba
Huq, Molla
http://hdl.handle.net/10361/6687
2016-11-23T10:42:49Z
Reservation wage of female volunteer community health workers in Dhaka urban slums: a bidding game approach
Alam, Khurshid; Tasneem, Sakiba; Huq, Molla
Background: BRAC, a large Bangladeshi NGO, recently has been using female volunteer community health workers (CHWs) in Dhaka urban slums to provide maternal and child health services. Due to erratic performance-based income and higher opportunity cost the urban CHWs lose motivation which contributes to high dropout and poor performance. This results challenges for the cost effectiveness and sustainability of the urban health program. CHWs also consider their performance-based income very low compare to their work load. So, CHWs raise their voice for a fixed income. In order to understand this problem we explored fixed income for CHWs and the correlates that influence it. We surveyed a sample of 542 current CHWs. We used bidding game approach to derive the equilibrium reservation wage for CHWs for providing full-time services. Then, we performed ordered logit models with bootstrap simulation to identify the determinants of reservation wage. Results: The average reservation wage of CHWs to continue their work as full-time CHWs rather than volunteer CHWs was US$24.11 which was three times higher than their current performance-based average income of US$ 8.03. Those CHWs received additional health training outside BRAC were 72% and those who joined with an expectation of income were 62% more likely to ask for higher reservation wage. On the contrary, CHWs who were burdened with household loan were 65% and CHWs who had alternative income generating scope were 47% less likely to ask for higher reservation wage. Other important factors we identified were BRAC village organization membership, competition with other health services providers, performance as a CHW, and current and past monthly CHW income. Conclusions: The findings of this study are relevant to certain developing countries such as Bangladesh and Tanzania which commonly use volunteer CHWs, and where poor retention and performance is a common issue due to erratic and performance-based income. So, the study has implications in improving retention of health workers as well as their level of performance. The study also suggests that the financial incentives provided to CHWs should be clearly based on their qualifications and opportunity cost to ensure a high performing and motivated health workforce.
This article was published in the Health Economics Review [© 2014, Alam et al.; licensee Springer.] and the definite version is available at : http://dx.doi.org/10.1186/s13561-014-0016-4 The Journal's website is at: http://healtheconomicsreview.springeropen.com/articles/10.1186/s13561-014-0016-4