Identifying and confirming demotivating factors for village health workers in rural communities of Bhutan

Background Bhutan achieved over 95% of health coverage through its primary health care network and geared towards achieving and ensuring Universal Health Coverage. About 62.2% of the Bhutanese people are rural dwellers, living in villages. Village health workers (VHWs) are essential for primary health care delivery at the community level in order to bridge the gap between the health care system and the communities. However, increasing numbers of VHWs leaving the health care system remain a challenge for Bhutan. This study intends to find existing problems of motivation and retention among VHWs in Bhutan and to devise appropriate strategies for making effective policy interventions. Methods This quantitative study with a cross‐sectional survey design aims to determine demotivating factors. One stage cluster sampling technique was applied for VHWs from 12 districts in three regions. Data were collected by the trained enumerators using a pre‐tested semi‐structured questionnaire. Results The Confirmatory factor analysis identified and confirmed a four‐factor model of demotivation among VHWs in Bhutan. Among the four factors, the social factor was the main factor for VHWs leaving the health care system. However, the holistic combination of both financial and non‐financial motivator needs to be taken into consideration. The content analysis revealed six areas of recommendation for improving motivation and retention among VHWs. Conclusion The study concluded that managers and policymakers must give more emphasis to non‐financial motivators through the holistic approach to existing altruism and intrinsic needs.