Insights and inspirations: A qualitative exploration of community health workers’ motivations in Myanmar and Bangladesh

Community Health Workers (CHWs) play significant roles in various settings, with their motivations and retention strategies widely studied. Yet, literature is sparse on CHWs from Myanmar, who are key to primary health care in marginalized and conflict-affected areas. This study explores the unique challenges these CHWs face, using firsthand accounts. Life story interviews, enhanced with a lifeline tool, were conducted with 34 CHWs from conflict-affected regions in Myanmar and in Rohingya camps in Bangladesh. Additionally, eight key informant interviews were held with leaders from organizations that work with CHWs. Data analysis was facilitated by NVivo 14 software and four layers of influence adapted from Urie Bronfenbrenner's ecological systems theory of human development. The findings reveal that, CHWs primarily joined organizations to acquire skills and knowledge. In Bangladesh, the focus was on job-related skills, whereas in Myanmar, healthcare skills were prioritized. Despite remuneration being inadequate, it remained crucial for retention, as did the sense of being valued by the community in Myanmar. Mental health support emerged as a potential need for CHWs. Funding deficits and fragmented support presented organizational challenges, thereby impacting both program implementation and retention of CHWs. To address these challenges, effective, sustainable CHW programs in conflict-affected regions require a shift towards long-term support for organizations and health systems. This includes focusing on CHWs' mental health and stakeholder engagement. Short-term, fragmented solutions may revert to pre-existing situations once removed. Sustainability planning is key to break the CHW turnover cycle and maximize investments in these contexts.