Mixed-methods study demonstrates that structural precarity constrains health worker motivation in TB and HIV care, highlighting the need for formal integration and reliable remuneration.
Key Points
Examine how organizational and structural conditions shape community health worker motivation and engagement in tuberculosis and HIV care through the lens of Self-Determination Theory.
Conducted a convergent mixed-methods study from March to October 2024 across four regions in Madagascar.
Surveyed 408 community health workers alongside five focus group discussions (n=26) and 24 interviews with institutional stakeholders.
Applied Self-Determination Theory within a socio-ecological model to assess the fulfillment of autonomy, relatedness, and competence.
Economic precarity was severe, with 74.3% of workers reporting monthly household earnings below 100,000 MGA (≈ $22.1) and 95.8% maintaining additional full-time occupations.