Motivating and demotivating factors for community health workers engaged in maternal, newborn and child health programs in low and middle-income countries: A systematic review

This systematic review aimed to synthesize primary research on motivating factors of community health workers (CHWs) for maternal, neonatal, and child health (MNCH) in low and middle-income countries (LMICs). Peer-reviewed literatures were systematically searched in five databases. Identified studies were then screened and selected for inclusion. The eligibility criteria were reported primary qualitative, quantitative, or mixed methods research, with participants being CHWs in LMICs who address MNCH, which investigated motivation or related concepts of retention, attrition, and performance. A thematic synthesis process was used to analyze findings of motivating factors, reported by included studies. Seventeen qualitative, quantitative, or mixed methods studies met inclusion criteria. Two overarching themes were developed: Levels of motivation (i.e. individual, community, and health system) and stages of motivation (i.e. recruitment, retention, and attrition). Nine sub-themes were further developed at the intersection of each level and stage of motivation. Each subtheme comprises the motivating factors that are influential to community health workers at each stage and level. These themes and sub-themes are presented in a Community Health Worker Motivation Model. The motivation model can be used to identify what motivating factors are relevant to community health workers motivation and the stakeholders necessary to address each motivating factor. Recruitment of community health workers for maternal, neonatal, and child health relies largely on individual level of motivation. At retention, individual level motivating factors remain influential; and community and health system begin to influence motivation positively. But, overall health systems in low and middleincome countries are demotivating the health workers rather than motivating them.