IFGH 2012: A Model for Motivation of Community Health Workers

January 30, 2012

Authors: Weiss J.1, Morrow M.2, Luz R.1, Tamming R.

Author Affiliations:1Concern Worldwide US, Rwanda, and Ireland, 2World Relief, Baltimore MD

Option 2– Lessons from the field; project and programme evaluations; and syntheses or analyses Presented as – Oral Presentation


The Rwanda Ministry of Health (MOH) has established a robust Community Health Structure, which includes four community health workers (CHWs) per village; These CHWs belong to a larger cooperative of 150-300 CHWs that meet on a quarterly basis at the cell (health facility) level and are managed and supervised from the health facility. Due to the large numbers of CHWs per cell, there are many limitations around CHW supervision that affects their motivation. This project sought to address this limitation.


We formed CHWs into 15-20 member peer support groups based on the Care Group model, and trained the groups to conduct community mobilization and behaviour change communication at the household level. Each CHW peer support group met on at least a monthly basis, and was led by the CHW Cell Coordinator. A total of 660 CHW peer support groups were formed in the six target districts, consisting of 13,166 CHWs. Through these efforts an average of 163,000 households were visited on a quarterly basis with key prevention messages, which dramatically increased household healthy practices.

Lessons learned:

CHW peer support groups were an effective mechanism to integrate health care delivery and health promotion activities at the village level. Rwanda MOH stakeholders viewed the model as a viable CHW peer supervision and support model aligned with MOH existing structures and policies. CHWs found the model to be a motivating factor in their work. Compared to CHWs working independently, CHWs working as a group provided greater peer support, developed a stronger commitment to implementing health activities, and found more creative solutions to problems.

Next steps:

The August 2011 end of project evaluation raised some questions about the sustainability of this peer support model and recommended testing and institutionalizing systematic peer support and supervision as a means of increasing motivation.


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