{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T17:56:55Z","timestamp":1785261415818,"version":"3.55.0"},"reference-count":65,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2024,8,1]],"date-time":"2024-08-01T00:00:00Z","timestamp":1722470400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Motivating Community Health Workers (CHWs)\u2014many of whom are volunteers\u2014is crucial for achieving Universal Healthcare Coverage (UHC) for Primary Healthcare (PHC) in resource-poor areas. In rural Nepal, PHC is mostly delivered by female CHWs, locally known as Female Community Health Volunteers (FCHVs), but little is known about them. This paper explores experiential factors influencing FCHVs\u2019 motivations, including how motivation intersects with women\u2019s livelihoods and consider what this means for achieving PHC in Nepal and globally. We conducted qualitative research in the hill and the Terai (flatland bordering India) areas of Nepal. Data were purposively collected through 31 semi-structured interviews (20 volunteers, 11 paid local health workers) and three focus group discussions with additional 15 volunteers. All interviews were audio-recorded, transcribed verbatim in Nepali and translated into English. Data were coded using NVivo10, analysed thematically at individual, organisational and community levels. FCHVs\u2019 motivations to volunteer was affected in several ways. At the individual level, participants wanted and were committed to voluntary work, yet the opportunity costs of volunteering, out-of-pocket expenditure and inadequate family support strained many of the women who were already overburdened. At the community level, perceived lack of appreciation of volunteer efforts by community members, who saw volunteers as paid health workers, undermined FCHVs motivation to volunteer. Finally, at the organizational level, a bureaucratic emphasis on recording and reporting, and lack of respect from local health workers undermined their motivation at work. Our paper illustrates how FCHVs from some of the poorest backgrounds can be highly motivated to volunteer, yet inadequate social and economic support across individual, organisational and community levels undermined this motivation, the security of their livelihoods, and thus wider efforts to achieve PHC. Financial investments are needed to compensate FCHVs, so that they remain motivated to deliver global health goals for PHC.<\/jats:p>","DOI":"10.1371\/journal.pgph.0003428","type":"journal-article","created":{"date-parts":[[2024,8,1]],"date-time":"2024-08-01T17:44:44Z","timestamp":1722534284000},"page":"e0003428","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":12,"title":["Exploring the motivations of female community health volunteers in primary healthcare provision in rural Nepal: A qualitative study"],"prefix":"10.1371","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2369-1476","authenticated-orcid":true,"given":"Sarita","family":"Panday","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edwin van","family":"Teijlingen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8122-9792","authenticated-orcid":true,"given":"Amy","family":"Barnes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,8,1]]},"reference":[{"issue":"1","key":"pgph.0003428.ref001","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1186\/s12960-018-0319-3","article-title":"Factors contributing to motivation of volunteer community health workers in Ethiopia: the case of four woredas (districts) in Oromia and Tigray regions.","volume":"16","author":"HA Jigssa","year":"2018","journal-title":"Human Resources for Health"},{"key":"pgph.0003428.ref002","volume-title":"WHO guideline on health policy and system support to optimize community health worker programmes","author":"World Health Organization","year":"2018"},{"key":"pgph.0003428.ref003","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1186\/1471-2458-13-847","article-title":"Effectiveness of community health workers delivering preventive interventions for maternal and child health in low- and middle-income countries: a systematic review.","volume":"13","author":"B Gilmore","year":"2013","journal-title":"BMC public health."},{"issue":"1","key":"pgph.0003428.ref004","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1186\/s12960-018-0304-x","article-title":"What do we know about community-based health worker programs? 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