Getting more than "claps": incentive preferences of voluntary community-based mobilizers in Tanzania

• Published in: Human resources for health 2019-12, Vol.17 (1), p.101-101, Article 101
• Main Authors: Kok, Maryse, Abdella, Dinu, Mwangi, Rose, Ntinginya, Mengi, Rood, Ente, Gassner, Jennifer, Church, Kathryn, Wheatley, Nkemdiri
• Format: Article
• Language: English
• Subjects: Abortion; Analysis; Cancer; Cancer screening; Cervical cancer; Clinics; Community health aides; Community health worker; Employee motivation; Employee performance; Family planning; Fertility clinics; Health; Identification cards; Incentives; Medical screening; Meetings; Monetary incentives; Motivation; Motor vehicle drivers; Qualitative research; Questionnaires; Reproductive health; Research methodology; Researchers; Retirement benefits; Studies; Tanzania; Workers; Workshops (Educational programs)
• ISSN: 1478-4491; 1478-4491
• DOI: 10.1186/s12960-019-0438-5

Marie Stopes Tanzania works with a voluntary cadre of 66 community-based mobilizers (CBMs), who are tasked with raising awareness, generating demand and providing referral to potential clients for family planning, comprehensive post-abortion care and cervical cancer screening. CBMs extend the reach of urban clinics to peri-urban communities, enhancing access to sexual and reproductive health services. In an effort to optimize performance of CBMs, a study was conducted to explore the drivers of CBM motivation and inform the design of an incentive scheme. Three focus group discussions with 17 CBMs and 11 interviews with CBM supervisors and managers were conducted in three clinics and the head office. After thematic analysis of transcripts, findings on motivational factors were discussed in a reflection workshop and informed the development of a discrete choice experiment (DCE) involving 61 CBMs as respondents. The DCE included eight choice questions on two incentive schemes, each consisting of five attributes related to remuneration, training, supervision, benefits and identification. For each attribute, different incentive options were presented, based on the outcomes of the qualitative assessment. The DCE results were analysed using conditional logistic regression. A variety of factors motivated CBMs. Most CBMs were motivated to conduct their work because of an intrinsic desire to serve their community. The most mentioned extrinsic motivational factors were recognition from the community and supervisors, monthly allowance, availability of supporting materials and identification, trainings, supervision and feedback on performance. Recommendations for improvement were translated into the DCE. Incentive attributes that were found to be significant in DCE analysis (p