Abstract
BackgroundThe contribution of community medicine distributors (CMD) to prompt health service delivery in areas described as “hard-to-reach” is important but the value of their work time remains unknown and thus makes it difficult to design appropriate regular financial incentives to motivate them. This makes CMDs feel their efforts are not recognized. An attempt to estimate the value of 54 CMDs’ work time involved in community case management of malaria (CCMm) in a rural district in Ghana is presented.MethodsTime spent by CMDs on CCMm activities were recorded for a period of 12 months to determine the work-time value. Cost analysis was performed in Microsoft Excel with data from CMD records and at 2007 market price in Ghana.ResultsA CMD spent 4.8 hours, [95% CI: 3.9; 5.3] on all CCMm-related activities per day. The time value of CMD work ranged from GH¢ 2.04 (US$ 2.24) to GH¢ 4.1 [US$ 4.6] per week and GH¢ 19.2 - 86.4 (US$ 21.10-94.95) per month. The gross wage outside CCMm as reported by CMD was GH¢ 58.4 [US$ 64.69] and value of foregone income of GH¢ 86.40 (US$94.95) per month, about 14-times higher than the monthly incentives of GH¢ 6.0 given by the CCMm programme.ConclusionThe value of work time and the foregone income of CMDs in CCMm are high and yet there are no regular and sustainable incentives provided for them. The results are significant to policy in designing incentives to motivate CMDs in large-scale implementation of CCMm.
Highlights
The contribution of community medicine distributors (CMD) to prompt health service delivery in areas described as “hard-to-reach” is important but the value of their work time remains unknown and makes it difficult to design appropriate regular financial incentives to motivate them
This paper presents estimates of the amount of work time of CMDs spent on community case management of malaria (CCMm) in a rural district of Ghana as well as valuations of the unpaid time offered by CMDs
A follow-up of 54 CMDs was performed in CCMm for a period of 12 months using time and motion study sheets [19] to document time spent on key activities of CCMm to estimate the value of work time of CMDs in CCMm
Summary
The contribution of community medicine distributors (CMD) to prompt health service delivery in areas described as “hard-to-reach” is important but the value of their work time remains unknown and makes it difficult to design appropriate regular financial incentives to motivate them This makes CMDs feel their efforts are not recognized. The use of CMDs for community case management of malaria (CCMm) have been implemented in Uganda, Ghana and Nigeria, where volunteers were tasked to dispense prepacked anti-malarials, organize behavioural change sessions and make referrals of severe fever cases Under this intervention, caregivers accessing care pay a token to the CMD which is collected by the District Health Management Team to serve as revolving fund to replenish drugs [7,8,9]. Assigning a “dollar-value” to a volunteer’s time remains debatable [12,13]
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