Mobilizing CHW internal motivation to improve program quality and sustainability

Through this paper I propose that reorienting Community Health Worker (CHW) health programs to maximize the internal motivation of these vital workers will improve program quality and sustainability with limited new inputs. Traditionally in human organizations for centuries worker motivation has been based on the idea that “the way to improve performance, increase productivity, and encourage excellence is to reward the good and punish the bad”. Modern psychological experimentation and examination of human productivity has found that utilizing this source of motivation is useful for unrelenting, routine, mechanical or boring tasks, but it is not as useful when creativity, maximization of performance, quality and commitment are desired. Pink identifies three elements of internal motivation: autonomy, mastery and purpose. I propose that these elements can be designed into most CHW projects to produce better outcomes. Project approaches such as Freedom from Hunger's (FH) Care Groups will be presented that are already using these elements successfully. FH's USAID-supported Care Group projects have achieved dramatic results, such as a 30% reduction in child mortality at $442 per life saved, as well as changes in nutritional status and behavioral changes in very short periods of time. These changes were brought about through utilization of only 65 paid CHWs who worked with a vast cadre of 4,100 Care Group Volunteers to serve an area with 1.1M people.