Motivation and Performance of Community Health Workers: Nothing New Under the Sun, and Yet….

Eric Sarriot,Melanie Morrow,Tom Davis,Henry Perry,Telesphore Kabore

doi:10.9745/ghsp-d-21-00627

Abstract

<h3>Key Messages</h3> We consider the types of incentives that motivate community health workers9 (CHWs) performance and the implications at 2 levels of systems analysis—first, for CHWs themselves and then for appropriate management of an invaluable human resource by CHW programs. The World Health Organization recommendations on commensurability of CHW compensation with the job demands—and corresponding professionalization—represent the culmination of decades of work, advances, forgetfulness, rediscovery, collective wisdom, and available evidence. Tapping into communities9 own organizing potential through volunteerism is, however, a force in both high-income and low- and middle-income countries. We offer predictions for the future direction of CHW programs: National CHW programs—whether implemented by states or non-state partners—will be a growing opportunity to viably strengthen national health systems. Partnerships between state and non-state actors will be key to sustain effective CHW programs in national PHC strategies at scale. The social-versus-institutional anchoring of CHW programs will be an enduring challenge for their performance and sustainability. Dual models (paid CHWs and volunteers), if ethically managed, will be a promising approach for efficiency and scale.

Highlights

GHSP has shared with some regularity research and practice papers on the recruitment, training, compensation, roles, support, potential, and performance of community health workers (CHWs)
In this issue of GHSP, Roy et al bring us to Bangladesh—a country with notable governmental and nongovernmental efforts to structure CHW programs for effective primary health care (PHC)—to consider what factors drive the motivation, and the performance, of CHWs.[4]
As we are in the age of “systems thinking” in global health, we consider 2 systems of a different order: the Motivation and Performance of Community Health Workers www.ghspjournal.org biological-psychosocial system of CHW workers as individuals and the social-institutional system in which CHW programs are anchored

Summary

INTRODUCTION

GHSP has shared with some regularity research and practice papers on the recruitment, training, compensation, roles, support, potential, and performance of community health workers (CHWs). A cursory reader well-versed in CHW programs (for example, the 20-year-old seminal publication of Bhattacharyya et al on CHW incentives and disincentives5) might be forgiven for pondering, “We already know that both financial and nonfinancial incentives matter if we want motivated and performing CHWs. What is new in this?” The question is timely as a new Health Research Policy and Systems[6] supplement issue (including a summation of lessons on incentives and remuneration of CHWs7) updates the work of Bhattacharyya et al.,[5] the CHW Reference Guide,[8] and more recently, the 29 country case studies by Perry on national CHW programs.[9] some findings recur across contextual studies and accrue a recognizable body of evidence, even if they do not have the sharp edges of controlled experiments. As we are in the age of “systems thinking” in global health, we consider 2 systems of a different order: the Motivation and Performance of Community Health Workers www.ghspjournal.org biological-psychosocial system of CHW workers as individuals and the social-institutional system in which CHW programs are anchored

PEOPLE ARE SYSTEMS TOO

CHW program

CONCLUSION

Findings

Peer Reviewed