Financial incentive for community health workers, a necessity for achieving universal health coverage: integrated literature review

Abstract

Community health workers (CHWs) are vital to achieve universal health coverage (UHC). They have been identified as effective workforce to improve access to primary health care particularly for underserved and hard to reach populations. Lack of appropriate incentives, with resulting high rates of turnover are common challenges in large-scale CHW program. Debates about paying community health workers typically focus on the trade-offs between reliance on volunteerism underpinned by intrinsic motivation of volunteers and the need to recognise and remunerate work fairly. Financial payment for CHWs will also help in increased employment, and women’s economic empowerment, tackling gender-based inequities, as seventy percent of CHWs globally are women. This study reviewed existing literature- published peer reviewed articles and grey literatures on financial incentives for community health workers and program considerations for effective implementation. Synthesis from the relevant studies revealed four relevant themes: need for financial incentives, categories of financial incentives, funding mechanisms for financial incentives and program considerations for effective implementation of financial incentives. The study provides program considerations for effective implementation of financial incentive for community health workers. There is need for countries to review their community health worker program design and establish enabling policy environment and implementation mechanisms for realistic and appropriate financial incentives for the community health workers based on their workload, responsibilities, and local context. Appropriate tools should be used to model the community health workers working hours which will guide in determining fair and commensurate renumeration and effective monitoring system established.

Community Health Workers’ Targeting of Women For Health and Nutrition Home Visits in Rural Tanzania: A Mixed-Methods Study

“…They were not paid a travel stipend for visiting households that were far away. Historically, payment to CHWs was considered unsustainable due to lack of funding [ 40 , 41 ]; however, there is now consensus that CHWs should be paid for economic and gender equity, as a majority of CHWs worldwide are females [ 40 , 42 ]. Payment should also be consistent with the expected workload and responsibilities, as lack of payment can contribute to a lack of motivation to complete program tasks, economic well-being, and psychosocial distress [ 39 , 40 , [43] , [44] , [45] ].…”

“…Payment should also be consistent with the expected workload and responsibilities, as lack of payment can contribute to a lack of motivation to complete program tasks, economic well-being, and psychosocial distress [ 39 , 40 , [43] , [44] , [45] ]. Payment, transportation support, and consistent management and supervision are important for scaling up and sustainability of CHW programming [ 39 , 42 , 46 ].…”