Background
South Africa faces a chronic shortage of professional health workers. Accordingly, community health workers (CHWs) are being employed to mitigate the ongoing deficiencies. In addition to facilitating linkages between communities and primary health care (PHC) facilities, CHWs are entrusted with a range of crucial tuberculosis (TB), HIV/AIDS and maternal health services. As increased access to quality service delivery hinges upon their motivation, this study investigated CHWs’ motivation to deliver systematic household contact TB investigation (SHCI).
Methods
In 2017, a cross-sectional survey was conducted among CHWs enrolled in the ward-based PHC outreach teams in the Mangaung Metropolitan District. Descriptive, exploratory factor analysis and multiple linear regression analysis were conducted to establish the dimensions, levels and determinants of CHW motivation. Statistical significance was determined at p ≤ 0.05.
Results
Out of 235 participants, the majority were female (89.2%). Participants’ median age was 39 (inter-quartile range: 33-45) years. Job satisfaction, burnout and team commitment characterised CHW motivation or lack thereof, together explaining 56.04% of the total variance, with a mean score of 51.59 (standard deviation: 5.14) out of 64. The full scale showed satisfactory internal consistency (Cronbach α: 0.734). The individual sub-scales also had acceptable internal consistency (Cronbach α—job satisfaction: 0.83; burnout: 0.83; and team commitment: 0.73). CHW category (i.e. formal — with at least phase 1 of standardised training vs. informal — with non-standardised training) and TB SHCI training and knowledge significantly influenced CHW motivation. Formal CHWs scored twice higher (β = 2.020; p = 0.009) than informal CHWs on the motivation scale. Motivation scores increased by 0.841 (p = 0.007) times with every unit increase in CHW TB SHCI knowledge. Scores were more than twice lower (β = -2.289; p = 0.003) among CHWs who did not attend TB SHCI training than those who did.
Conclusion
The high mean score implies that the CHWs were motivated to perform TB SHCI. The TB programme in the Free State should ensure sustained CHW motivation to effect improved access to quality TB SHCI service provision. To this end, the TB programme should pay close attention to the CHWs’ formalisation, TB knowledge and training.