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Motivating Factors of Community Health Workers in the Kadutu Urban Health Zone in Eastern Democratic Republic of Congo

Background: Sub-Saharan countries need more attention on how to achieve the health-related Sustainable Development Goals by 2030. Involving community health workers (CHWs) is seen as a solution to fight poverty only when they are well motivated to better perform their tasks. Despite recent reconsideration of CHWs in the health system in developing countries, the issue of their motivation remains to be of debate. 
 
Methods:This article aims to determine the degree of motivation and motivating factors of CHWs as well as the incentive structure related to in the Kadutu Urban Health Zone (KUHZ) in Eastern Democratic Republic of Congo (DRC) in Sub-Saharan Africa. To do so, we undertook a cross-sectional study in the KUHZ from March to July 2017, sampling 240 CHWs from 12 health centres that compose the health zone and using mainly 15 conventional motivators. 
 
Findings: (i) motivation of CHWs in the KUHZ is at medium level; that is, 59.1%. (ii) Except the participation in distribution of mosquito nets as well as of Mebendazol/Vitamin A with earnings, all other mainstream factors, such as respect by people, training, supervision, and participation in community work and in the National Vaccination Days are not motivating. (iii) Interest in the vaccination campaigns, allocation to family members, free access to health care or at reduced cost, Savings and Loan Association within the Health Facility Committee, regular equipment, transport fee, and trainings have an influence on CHWs’ motivation. 
 
Interpretation: A combination of both social and economic incentives that vary from being intrinsic and extrinsic, both immaterial and material, including financial would be more incentivizing. We recommend paying attention to the regular assessment of the context-specific incentive structure of CHWs that promote good results and retention, particularly the creation of the Savings and Loan Association within the Health Facility Committee. 
 
Funding Statement: Data collection was supported by the Institut Superieur des Techniques Medicales de Bukavu while in the writing up phase of the paper, the first author has been funded by DfiD-ODI through the PPP (Power, Poverty and Politics) project in the DRC and the Social Science Centre for African Development-KUTAFITI. 
 
Declaration of Interests: The authors declare there is no conflict of interest. 
 
Ethics Approval Statement: This study was presented as a Bachelor of sciences’ thesis in public health at the Bukavu University college/Institut Superieur des Techniques Medicales de Bukavu (ISTM-Bukavu) in the academic year 2016-2017. Before such achievement, the Academic Board of the Public Health Department of the same University College approved this study protocol in 2016 before we conducted it.