1. Equity for health delivery: Opportunity costs and benefits among Community Health Workers in Rwanda
- Author
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Ornella Masimbi, Jean Muhire, Ellen Rafferty, Olivia Rozanski, Hellen Amuguni, Janna M. Schurer, and Kelly Fowler
- Subjects
Male ,Economics ,Service delivery framework ,Social Sciences ,Transportation ,Global Health ,Care provision ,Geographical Locations ,0302 clinical medicine ,Health care ,Medicine and Health Sciences ,Salaries ,Global health ,Public and Occupational Health ,030212 general & internal medicine ,Health Systems Strengthening ,Community Health Workers ,Multidisciplinary ,030503 health policy & services ,Middle Aged ,Socioeconomic Aspects of Health ,Health Education and Awareness ,Workforce ,Income ,Engineering and Technology ,Medicine ,Female ,Health education ,Job satisfaction ,0305 other medical science ,Research Article ,Adult ,Science ,Job Satisfaction ,Young Adult ,03 medical and health sciences ,Nursing ,Humans ,Motivation ,Health Care Policy ,Poverty ,business.industry ,Rwanda ,Health Care ,Cross-Sectional Studies ,Labor Economics ,People and Places ,Africa ,business ,Delivery of Health Care ,Finance - Abstract
Community Health Workers (CHWs) play a vital role delivering health services to vulnerable populations in low resource settings. In Rwanda, CHWs provide village-level care focused on maternal/child health, control of infectious diseases, and health education, but do not receive salaries for these services. CHWs make up the largest single group involved in health delivery in the country; however, limited information is available regarding the socio-economic circumstances and satisfaction levels of this workforce. Such information can support governments aiming to control infectious diseases and alleviate poverty through enhanced healthcare delivery. The objectives of this study were to (1) evaluate CHW opportunity costs, (2) identify drivers for CHW motivation, job satisfaction and care provision, and (3) report CHW ideas for improving retention and service delivery. In this mixed-methods study, our team conducted in-depth interviews with 145 CHWs from three districts (Kirehe, Kayonza, Burera) to collect information on household economics and experiences in delivering healthcare. Across the three districts, CHWs contributed approximately four hours of volunteer work per day (range: 0–12 hrs/day), which translated to 127 684 RWF per year (range: 2 359–2 247 807 RWF/yr) in lost personal income. CHW out-of-pocket expenditures (e.g. patient transportation) were estimated at 36 228 RWF per year (range: 3 600–364 800 RWF/yr). Participants identified many benefits to being CHWs, including free healthcare training, improved social status, and the satisfaction of helping others. They also identified challenges, such as aging equipment, discrepancies in financial reimbursements, poverty, and lack of formal workspaces or working hours. Lastly, CHWs provided perspectives on reasonable and feasible improvements to village-level health programming that could improve conditions and equity for those providing and using the CHW system.
- Published
- 2020