Exploring Peer Mentor Retention in Tanzania
Peer mentors, expert patients, and other non-clinical community-based workers are increasingly relied upon to be a bridge between the HIV patient community and the health facility. In Tanzania, where there is a critical health workforce shortage, the USAID Health Care Improvement (HCI) and later the ASSIST projects supported the implementation of a patient self-management model in Morogoro Region, starting in 2011. The aim was to improve ART uptake among people living with HIV (PLHIV). Trained peer mentors were engaged to reach PLHIV in the community and connect them to facility-based services and educate them on the importance of adhering to treatment. Two years following the conclusion of ASSIST support, it was found that some peer mentors had continued in their role, while others had stopped. The objective of this exploratory study was to examine why some peer mentors were retained.
Through qualitative interviews with peer mentors we found that peer mentors were motivated by wanting to help their fellow patients, which was viewed as the most important aspect of the work. Only those retained in the position were motivated by a positive experience with treatment at the facility. Reasons for ceasing as a peer mentor included transportation difficulties, need to care for sick family, lack of salary/incentives, and personal age/illness. One respondent reported poor treatment from facility staff as pushing her to stop working as a peer mentor.
Facility staff felt that peer mentors relieved some of their workload by taking on some paper work and health education responsibilities, and recognized that peer mentors had access to patient communities that facility staff did not. Facility staff perceived those peer mentors who stopped working as lazy or uncommitted. Other reasons cited by facility staff included not being adherent to treatment, not understanding it was a volunteer position, finding paying work, and lack of transportation.
Recommendations for improving peer mentor initiatives included offering incentives, providing training and job aids, and offering a workspace at the facility and uniforms or identification.