{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T16:12:08Z","timestamp":1786464728331,"version":"build-2736575974"},"reference-count":45,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2021,10,19]],"date-time":"2021-10-19T00:00:00Z","timestamp":1634601600000},"content-version":"unspecified","delay-in-days":18,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,8,24]]},"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Community health workers (CHWs) played important roles in supplementing scarce healthcare workforce in Sierra Leone during the Ebola outbreak, causing the government to launch the National Community Health Worker Policy 2016\u20132020. This study evaluated this ambitious policy and examined CHWs\u2019 sustainability through their job satisfaction and the underlying factors to inform new policy recommendations, especially the implication for COVID-19 containment.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>A mixed-methods approach applying structured questionnaires and semistructured interviews.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting and participants<\/jats:title>\n                  <jats:p>188 CHWs in Bombali District (key Ebola-stricken areas) of Sierra Leone, 184 of them participated in follow-up interviews.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Primary and secondary outcome measures<\/jats:title>\n                  <jats:p>Quantitative and qualitative elements were triangulated to improve robustness of investigation: job satisfaction was measured by the Minnesota Satisfaction Questionnaire (MSQ), and factors associated with job satisfaction were identified through thematic analysis and multivariable logistic regression.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The MSQ score of CHWs in Sierra Leone was 65.09, extremely low even among low-income and middle-income countries. Five themes (grouped from 16 subthemes) emerged through the semistructured interviews and were tested quantitatively. Payment was CHWs\u2019 top concern. Low stipend and payment tardiness were significantly associated with dissatisfaction. Those with Ebola experience were 5.20 times (95% CI 1.51 to 17.95, p=0.009) more likely to be dissatisfied. This study also found that working conditions, medical material supplies and career development were far from what the CHW policy promised. CHWs\u2019 commitment was the only \u2018positive\u2019 theme, and their intrinsic job satisfaction (mean=3.61) was much higher than the extrinsic job satisfaction (mean=2.72).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Some critical components of the 2016 National Community Health Worker Policy, aiming to promote CHWs and strengthen primary healthcare, have severe shortfalls in practice. The Sierra Leone government should address the underlying factors that have impaired CHWs\u2019 job satisfaction to ensure sustainability of its CHW network, especially during the combat against COVID-19.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-051645","type":"journal-article","created":{"date-parts":[[2021,10,20]],"date-time":"2021-10-20T14:12:54Z","timestamp":1634739174000},"page":"e051645","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Community health workers\u2019 job satisfaction in Ebola-stricken areas of Sierra Leone and its implication for COVID-19 containment: a cross-sectional mixed-methods study"],"prefix":"10.1136","volume":"11","author":[{"given":"Osman","family":"Koroma","sequence":"first","affiliation":[{"name":"Vanke School of Public Health, Tsinghua University, Beijing, China"},{"name":"District Health Management Team, Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6603-1975","authenticated-orcid":false,"given":"Yanhua","family":"Chen","sequence":"additional","affiliation":[{"name":"School of Medicine, Tsinghua University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peicheng","family":"Wang","sequence":"additional","affiliation":[{"name":"School of Medicine, Tsinghua University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geer","family":"Chen","sequence":"additional","affiliation":[{"name":"PBC School of Finance, Tsinghua University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Lin","sequence":"additional","affiliation":[{"name":"Institute for Hospital Management, Tsinghua University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming Yen","family":"Cheung","sequence":"additional","affiliation":[{"name":"China Primary Care, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3545-1525","authenticated-orcid":false,"given":"Jiming","family":"Zhu","sequence":"additional","affiliation":[{"name":"Vanke School of Public Health, Tsinghua University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,10,20]]},"reference":[{"key":"2025101814324309000_11.10.e051645.1","first-page":"Cd004015","article-title":"Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases","volume":"2010","author":"Lewin","year":"2010","journal-title":"Cochrane Database Syst Rev"},{"key":"2025101814324309000_11.10.e051645.2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2016-000141"},{"key":"2025101814324309000_11.10.e051645.3","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2019-001790"},{"key":"2025101814324309000_11.10.e051645.4","doi-asserted-by":"crossref","first-page":"E467","DOI":"10.1016\/S2214-109X(17)30152-3","article-title":"Community health workers: emerging from the shadows?","volume":"5","year":"2017","journal-title":"Lancet Glob Health"},{"key":"2025101814324309000_11.10.e051645.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)62479-X"},{"key":"2025101814324309000_11.10.e051645.6","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.15.164020"},{"key":"2025101814324309000_11.10.e051645.7","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30735-2"},{"key":"2025101814324309000_11.10.e051645.8","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1097\/JAC.0000000000000337","article-title":"COVID-19 crisis creates opportunities for Community-Centered population health: community health workers at the center","volume":"43","author":"Goldfield","year":"2020","journal-title":"J Ambul Care Manage"},{"key":"2025101814324309000_11.10.e051645.9","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2020-002550"},{"key":"2025101814324309000_11.10.e051645.10","article-title":"Community health workers during the Ebola outbreak in guinea, Liberia, and Sierra Leone","volume":"8","author":"Miller","year":"2018","journal-title":"J Glob Health"},{"key":"2025101814324309000_11.10.e051645.11","unstructured":"Sierra Leone Ministry of Health and Sanitation . 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GDL report Sierra Leone-Bombali district 2017."},{"key":"2025101814324309000_11.10.e051645.25","unstructured":"UN Office for the Coordination of Humanitarian Affairs . 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