Perceived Challenges and Their Influence on Performance Motivation among Fieldworkers in Sindh’s Expanded Programme on Immunization

Abstract

Background: Pakistan’s Expanded Programme on Immunization (EPI), launched in 1978, aims to provide routine immunization to all children under one year of age. However, multiple challenges persist, including vaccine stock-outs, inadequate cold-chain management, weak microplanning, insufficient social mobilization, and poor documentation. This study aimed to assess the current level of performance motivation among vaccinators and Lady Health Workers (LHWs) involved in immunization delivery, and to identify factors influencing their motivation.

Methodology: A cross-sectional study design was employed. Drawing on prior research highlighting the multifaceted determinants of motivation at individual, organizational, and societal levels, structured data collection tools were used to evaluate performance motivation and identify existing gaps.

Results: Among vaccine providers, 87.91% were female and 12.09% were male vaccinators engaged in routine immunization. The highest levels of motivation were associated with the nature of responsibilities and autonomy (mean score: 4.76). Training was identified as a key contributor to capacity building (mean: 4.69), followed by peer support (mean: 4.66) and supportive supervision (mean: 4.64). Conversely, dissatisfaction with salaries and incentives, along with limited recognition, were major factors contributing to reduced motivation.

Conclusion: Performance motivation among vaccine providers is strongly influenced by supportive supervision, peer support, and the nature of their responsibilities. However, inadequate salaries and incentives significantly undermine motivation. Strengthening financial and non-financial incentives is essential to enhance workforce motivation and improve immunization service delivery.