Table 4 CERQual summary of qualitative findings
Review findings | Confidence in the evidence | Explanation of confidence in the evidence assessment | Contributing studies | |||
|---|---|---|---|---|---|---|
Programme design factors | Financial incentives | |||||
Financial incentives were a great motivation for CHVs and those CHVs who depended on their role for financial support are more likely to remain as CHVs and more likely to be active CHVs | Moderate | Moderate concerns regarding methodological limitations | Sarma (2020), Aseyo (2018), George (2017), Osindo (2016), Odhiambo (2016), Swartz (2015), Alam (2012), Boros (2011), Alam (2009), Laston (1993) | |||
Factors related to human resource management | Non-financial factors | |||||
Job satisfaction and self-identity | Appreciation of the work carried out by members of the community, and being recognized personally because of their home visits, proved to be motivating factors for the community health workers. The role also brought them a sense of identity and satisfaction | Moderate | Serious concerns regarding methodological limitations and moderate volume of data available | George (2017), Osindo (2016), Lopes (2012), Laston (1993) | ||
Community trust | Enhanced CHW motivation while lack of it led to demotivation | |||||
Social status, prestige, and respect | Being a volunteer brought prestige, respect and recognition/acknowledgement to the CHVs thus being a source of motivation for them to continue working as CHVs | Moderate | Moderate concerns regarding methodological limitations and data adequacy | George (2017), Osindo (2016), Alam (2012), Lopes (2012), Alam (2009) Laston (1993) | ||
Job opportunities | Becoming a volunteer increased opportunity of getting a paid job | Moderate | Moderate concerns regarding methodological limitations and serious concerns about data adequacy | Goudet (2018) Swartz (2015), Laston (1993), | ||
Training | ||||||
Increased knowledge and awareness levels of CHVs thus making them more credible to the community | Moderate | Moderate concerns on methodological limitations and the volume of data | Sarma (2020), Goudet (2018), Aseyo (2018), Osindo (2016), George (2017), Laston (1993) | |||
Supplies and resources | ||||||
Lack of supplies impacted negatively on community visits to health facilities hence hindering CHV performance | Moderate | Moderate methodological limitations and serious concerns about the low volume of data | Sarma (2020), George (2017), Osindo (2016), Odhiambo (2016), Aseyo (2018), Laston (1993) | |||
Lack of proper protective equipment by CHVs resulted in low treatment coverage | ||||||
Supplies and materials play not only a functional role in the execution of CHVs' duties, but also a symbolic role in CHV relationships with their communities | ||||||
Provision of job aids help CHVs feel more confident in counselling and giving targeted messages | ||||||
“Receiving some type of an identification badge, a sari, an umbrella or a bag would be helpful in their work.” | ||||||
Health system linkage | ||||||
(Relationship between CHVs and other healthcare workers) | Attitudes of other health staff had an impact on how CHVs feel and performed. Lack of acknowledgement and recognition by the other healthcare staff caused demotivation in the profession | Moderate | Moderate concerns on methodological limitations and the volume of data | George (2017), Osindo (2016), Odhiambo (2016), Lopes (2012), Boros (2011), Laston (1993) | ||
Family support | ||||||
Relationship between CHVs and their families | Family support of the role played by a CHV is key to the CHV’s level of activity. Disapproval leads to CHV dropout | Moderate | Moderate concerns on methodological limitations and the volume of data | George (2017), Alam (2012), Alam (2009), Laston (1993) | ||
Gendered Household roles and duties: Female CHVs with no or fewer household responsibilities are more likely to remain as CHVs | Low | Moderate concerns on methodological limitations and the low volume of data | Alam (2009), Laston (1993) | |||
Programme design factors | Supportive supervision | |||||
Supportive supervision seen as a source of motivation for CHVs | Moderate | Moderate concerns on methodological limitations and serious concerns about the low volume of data | Aseyo (2018), Karuga (2017), Odhiambo (2016) | |||
Factors related to human resource management | CHV personal characteristics | |||||
Age | Affected interaction between the CHEWs and CHVs. A supervisor’s age in relation to the supervisees affected whether the supervisor would be able to provide adequate supervision | Low | Serious concerns regarding methodological limitations, minor concerns on partial relevance and serious concerns about the low volume of data | Karuga (2017) | ||
Prior experience with health condition | Prior experience of ill health or condition seen as a motivation of becoming a CHV | Low | Serious concerns on methodological limitations and the low volume of data | George (2017) | ||
Broad contextual factors | Community context factors | |||||
Insecurity | Insecurity and inaccessibility of certain neighbourhoods impacted negatively on CHV performance | Moderate | Moderate concerns on methodological limitations and the low volume of data | Odhiambo (2016), Osindo (2016), Lopes (2012) | ||
Gender | Women are seen as the ‘natural’ providers of care and it is assumed that this is what shapes women’s ability and their motivation to engage in CHV work | Low | Serious concerns on methodological limitations and the low volume of data | Swartz (2015) | ||
African ethic of Ubuntu | It is natural for African people to care for another | Low | Serious concerns on methodological limitations and the low volume of data | Swartz (2015) | ||
Economic contextual factors | ||||||
Demand for financial or material support | Households expected tangible support from CHVs, which some CHVs provided from their own resources out of sympathy and to increase their acceptance in the community | Moderate | Moderate concerns on methodological limitations and the volume of data | Aseyo (2018), Goudet (2018), Odhiambo (2016), Osindo (2016) | ||