Why do village health workers drop out

In each of the 8 provinces of the Solomon Islands which have a combined rural population of 300000 there are separate Village Health Worker (VHW) programs. From 1978 to 1991 335 VHWs were trained to provide simple curative and preventive services and health education on a part-time basis. The VHWs earned an average of US$13.67/month. The average annual attrition rate since 1978 was 4.8% and the provincial rate for the 13-year period ranged from 43% to 78%. If the figures for the 51 VHWs who had upgraded their positions to nurses aids or other posts were excluded the overall attrition rate would be 47%. The cost-effectiveness of VHW programs can be measured by examining attrition rates and reasons why VHWs leave their jobs. This information is also helpful in planning and in detecting problems. Thus 64 (50%) working and 66 (32%) non working VHWs as well as a male an a female observer from each of 199 villages responded to a survey designed to gather information on attrition. The average time a person worked as a VHW was 4.9 years and attrition was higher in the first 5 years (10%) than in following years (3.2%). When the data were submitted to multivariate analysis it became clear that attrition occurred when VHWs were trained before they reached age 20 and when their remuneration was irregular; only 58% of VHWs surveyed had been paid regularly and 66 of the non working VHWs surveyed had quit because of pay-related reasons. 92% of the workers thought that the monthly allowance should be doubled but this factor could not be associated with attrition. Many of the younger workers abandoned the job of VHW when they married and sought other employment to support their families or had children to tend. For others the VHW post was a steppingstone to becoming a nurse. In the Solomon Islands local communities try to have their VHW posts upgraded to that of nurses aid. If this practice were restricted more VHWs would drop out. By understanding attrition planners are able to predict manpower requirements and define selection criteria. It is useful for example to know that younger single candidates for VHW positions are more likely to drop out that older married candidates. It is also important that VHWs receive regular and adequate pay.