Community health workers at the dawn of a new era: 8. Incentives and remuneration

Christopher J Colvin,Henry B Perry,Steve Hodgins

doi:10.1186/s12961-021-00750-w

Christopher J Colvin, Henry B Perry + Show 1 more

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https://doi.org/10.1186/s12961-021-00750-w

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Abstract

BackgroundThis is the eighth in our series of 11 papers on “CHWs at the Dawn of a New Era”. Community health worker (CHW) incentives and remuneration are core issues that affect the performance of individual CHWs and the performance of the overall CHW programme. A better understanding of what motivates CHWs and a stronger awareness of the social justice dimensions of remuneration are essential in order to build stronger CHW programmes and to support the professionalization of the CHW workforce.MethodsWe provide examples of incentives that have been provided to CHWs and identify factors that motivate and demotivate CHWs. We developed our findings in this paper by synthesizing the findings of a recent review of CHW motivation and incentives in a wide variety of CHW programmes with detailed case study data about CHW compensation and incentives in 29 national CHW programmes.ResultsIncentives can be direct or indirect, and they can be complementary/demand-side incentives. Direct incentives can be financial or nonfinancial. Indirect incentives can be available through the health system or from the community, as can complementary, demand-side incentives. Motivation is sustained when CHWs feel they are a valued member of the health system and have a clear role and set of responsibilities within it. A sense of the “do-ability” of the CHW role is critical in maintaining CHW motivation. CHWs are best motivated by work that provides opportunities for personal growth and professional development, irrespective of the direct remuneration and technical skills obtained. Working and social relationships among CHWs themselves and between CHWs and other healthcare professionals and community members strongly shape CHW motivation.ConclusionOur findings support the recent guidelines for CHWs released by WHO in 2018 that call for CHWs to receive a financial package that corresponds to their job demands, complexity, number of hours worked, training, and the roles they undertake. The guidelines also call for written agreements that specify the CHW’s role and responsibilities, working conditions, remuneration, and workers’ rights.

Highlights

Introduction and tensions confronting programsBMC Health Re Policy Syst. 2020. https://doi.org/10.1186/s12961-021-00752-8. 2
We reviewed the literature to identify what kinds of incentives and remuneration have been offered to community health workers (CHWs), how these incentives have influenced Community health worker (CHW) motivation, and how programmatic and contextual factors have shaped the relationships between incentives and CHW motivation
This paper has described the range and types of incentives offered to CHWs and the underlying factors affecting CHW motivation in a number of different domains, including the ways incentives work at the individual level, the role of the health system and community context, the impact of broader cultural, political, and economic realities on CHW incentives and motivation, and the importance of approaching incentive strategies and motivation as a process that unfolds over time and needs to be managed as such

Summary

Introduction

Introduction and tensions confronting programsBMC Health Re Policy Syst. 2020. https://doi.org/10.1186/s12961-021-00752-8. 2. Community health worker (CHW) incentives and remuneration are core issues that affect the performance of individual CHWs and the performance of the overall CHW programme. The most common strategy for developing and sustaining motivation in CHW programmes centres on the use of discrete incentives, often framed in a fairly narrow fashion, as specific forms of reward—like payments, salaries, promotions, or awards for specific tasks or levels of performance. One can define incentives as any factor that increases motivation to engage and perform well in CHW work. This more expansive model of incentives is rooted in the idea that the factors that motivate CHWs are far more numerous and complex than just the explicit financial or nonfinancial incentives offered by programmes

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