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Performance of female volunteer community health workers in Dhaka urban slums


  • Alam, Khurshid
  • Tasneem, Sakiba
  • Oliveras, Elizabeth


Volunteer community health workers (CHWs) are one approach to addressing the health workforce crisis in developing countries. BRAC, a large Bangladeshi NGO, a pioneer in this area, uses female volunteer CHWs as core workers in its health programs. After 25 years of implementing the CHW model in rural areas, BRAC has begun using female CHWs in urban slums through its community-based mother, newborn and child health interventions. However, the program experienced suboptimal performance among CHWs, with a high percentage of them remaining in their positions but becoming “inactive”, not truly participating in daily community health activities. This suggests a need to better understand the relative importance of factors affecting their active participation and to recommend strategies for improving their participation. This mixed-method study included a descriptive correlational design to assess factors relating to level of activity of CHWs and focus group discussions to explore solutions to these problems. A sample of 542 current female CHWs from project areas participated in the survey. Financial incentives were the main factor linked to the activity of CHWs. CHWs who thought that running their families would be difficult without CHW income had more than three times greater odds to become active. In addition, social prestige and positive community feedback to the CHWs were important non-financial factors associated with level of activity. In order to improve volunteer CHWs' performance, a combination of financial and non-financial incentives should be used.

Suggested Citation

  • Alam, Khurshid & Tasneem, Sakiba & Oliveras, Elizabeth, 2012. "Performance of female volunteer community health workers in Dhaka urban slums," Social Science & Medicine, Elsevier, vol. 75(3), pages 511-515.
  • Handle: RePEc:eee:socmed:v:75:y:2012:i:3:p:511-515
    DOI: 10.1016/j.socscimed.2012.03.039

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    References listed on IDEAS

    1. Stekelenburg, Jelle & Kyanamina, Sindele Simasiku & Wolffers, Ivan, 2003. "Poor performance of community health workers in Kalabo District, Zambia," Health Policy, Elsevier, vol. 65(2), pages 109-118, August.
    2. Franco, Lynne Miller & Bennett, Sara & Kanfer, Ruth & Stubblebine, Patrick, 2004. "Determinants and consequences of health worker motivation in hospitals in Jordan and Georgia," Social Science & Medicine, Elsevier, vol. 58(2), pages 343-355, January.
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    Cited by:

    1. Martin, Stephanie L. & Muhomah, Teresia & Thuita, Faith & Bingham, Allison & Mukuria, Altrena G., 2015. "What motivates maternal and child nutrition peer educators? Experiences of fathers and grandmothers in western Kenya," Social Science & Medicine, Elsevier, vol. 143(C), pages 45-53.
    2. Druetz, Thomas & Kadio, Kadidiatou & Haddad, Slim & Kouanda, Seni & Ridde, Valéry, 2015. "Do community health workers perceive mechanisms associated with the success of community case management of malaria? A qualitative study from Burkina Faso," Social Science & Medicine, Elsevier, vol. 124(C), pages 232-240.
    3. Edward, Anbrasi & Branchini, Casey & Aitken, Iain & Roach, Melissa & Osei-Bonsu, Kojo & Arwal, Said Habib, 2015. "Toward universal coverage in Afghanistan: A multi-stakeholder assessment of capacity investments in the community health worker system," Social Science & Medicine, Elsevier, vol. 145(C), pages 173-183.


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