Documenting Community Health Worker Compensation Schemes and Their Perceived Effectiveness in Seven sub-Saharan African Countries: A Qualitative Study.
IF 2.5 3区 医学Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Alyssa L Davis, Lola Flomen, Jehan Ahmed, Djibrilla Maiga Arouna, Amos Asiedu, Maman Bacharou Badamassi, Ousmane Badolo, Moumouni Bonkoungou, Ciro Franco, Zachariah Jezman, Victoria Kalota, Beh Kamate, Daniel Koko, John Munthali, Raphael Ntumy, Patrick Sichalwe, Oumar Yattara
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引用次数: 0
Abstract
Introduction: Community health worker (CHW) incentives and remuneration are core issues affecting the performance of CHWs and health programs. There is limited documentation on the implementation details of CHW financial compensation schemes used in sub-Saharan African countries, including their mechanisms of delivery and effectiveness. We aimed to document CHW financial compensation schemes and understand CHW, government, and other stakeholder perceptions of their effectiveness.
Methods: A total of 68 semistructured interviews were conducted with a range of purposefully selected key informants in 7 countries: Benin, Burkina Faso, Ghana, Malawi, Mali, Niger, and Zambia. Thematic analysis of coded interview data was conducted, and relevant country documentation was reviewed, including any documents referenced by key informants, to provide contextual background for qualitative interpretation.
Results: Key informants described compensation schemes as effective when payments are regular, distributions are consistent, and amounts are sufficient to support health worker performance and continuity of service delivery. CHW compensation schemes associated with an employed worker status and government payroll mechanisms were most often perceived as effective by stakeholders. Compensation schemes associated with a volunteer status were found to vary widely in their delivery mechanisms (e.g., cash or mobile phone distribution) and were perceived as less effective. Lessons learned in implementing CHW compensation schemes involved the need for government leadership, ministerial coordination, community engagement, partner harmonization, and realistic transitional financing plans.
Conclusion: Policymakers should consider these findings in designing compensation schemes for CHWs engaged in routine, continuous health service delivery within the context of their country's health service delivery model. Systematic documentation of the tasks and time commitment of volunteer status CHWs could support more recognition of their health system contributions and better determination of commensurate compensation as recommended by the 2018 World Health Organization Guidelines on Health Policy and System Support to Optimize Community Health Worker Programs.
期刊介绍：
Global Health: Science and Practice (GHSP) is a no-fee, open-access, peer-reviewed, online journal aimed to improve health practice, especially in low- and middle-income countries. Our goal is to reach those who design, implement, manage, evaluate, and otherwise support health programs. We are especially interested in advancing knowledge on practical program implementation issues, with information on what programs entail and how they are implemented. GHSP is currently indexed in PubMed, PubMed Central, POPLINE, EBSCO, SCOPUS,. the Web of Science Emerging Sources Citation Index, and the USAID Development Experience Clearinghouse (DEC).
TOPICS:
Issued four times a year, GHSP will include articles on all global health topics, covering diverse programming models and a wide range of cross-cutting issues that impact and support health systems. Examples include but are not limited to:
Health:
Addiction and harm reduction,
Child Health,
Communicable and Emerging Diseases,
Disaster Preparedness and Response,
Environmental Health,
Family Planning/Reproductive Health,
HIV/AIDS,
Malaria,
Maternal Health,
Neglected Tropical Diseases,
Non-Communicable Diseases/Injuries,
Nutrition,
Tuberculosis,
Water and Sanitation.
Cross-Cutting Issues:
Epidemiology,
Gender,
Health Communication/Healthy Behavior,
Health Policy and Advocacy,
Health Systems,
Human Resources/Training,
Knowledge Management,
Logistics and Supply Chain Management,
Management and Governance,
mHealth/eHealth/digital health,
Monitoring and Evaluation,
Scale Up,
Youth.
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