Table 4 Attraction and retention: CHW expectations, HRM practices and outcomes

Skills and knowledge enhancement

• Initial and refresher training

• Further improvement wanted: frequency and quality of refresher training

• Most CHWs are female

• CHWs more likely to be older

• Enhancing skills for main role

• Opportunities for further training

• Shortage of CHWs

• Many candidates apply to be CHW in Zimbabwe

• Enhancing health skills to serve families at home

• Average length of service: 8–10 years

Financial benefits

• Provision of financial incentives

• Irregular/insufficient per diems and transport reimbursements

• Few CHWs leave

• Per diems for training and other events

• Younger CHWs are more likely to leave; leave for paid jobs; young women leave when they marry

• Free/reduced fees for healthcare for CHWs and families

• Fixed stipends – per time worked or per activity

• Stipends: inadequate amount; delays in receiving stipends

• Incentives from health campaigns, for example, immunization

• No written guidelines on incentives for CHWs

• Lunch and travel allowance for meeting attendance

CHW role fits with other roles

• Exemption from communal labour; help with farming

• Use of job description varied: job described in training or CHW has job description or no job description

• Manageable with other job

• Use of job description

• Manageable with other responsibilities such as farm work, looking after home and family

• Irregular supervision by health centre supervisors

• Supervision: reporting to supervisors; regular meetings with supervisors; supervisory visits to community

• Supervision does not monitor workload

• Community support for farm work often lacking

Social status and prestige

• Provision of t-shirts, uniforms, badges, etc. to aid recognition as health worker

• CHWs not always valued in community

• Seen as a “Doctor” – community status and respect

• CHWs not always supported/respected by health staff

• Recognition as a health worker

• Recognition by the community; official ceremony when CHWs are recruited

• Lack of incentives such as t-shirts, ID badges, equipment for gardening (formerly provided by NGOs)