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The effect of payment and incentives on motivation and focus of community health workers: five case studies from low- and middle-income countries.
Singh, Debra; Negin, Joel; Otim, Michael; Orach, Christopher Garimoi; Cumming, Robert.
Afiliação
  • Singh D; Research and Collaboration, Kimanya-Ngeyo Foundation for Science and Education, Jinja, Uganda. Debbie@Kimanya.org.
  • Negin J; School of Public Health, University of Sydney, Sydney, Australia. joel.negin@sydney.edu.au.
  • Otim M; School of Allied Health | Faculty of Health Sciences, Australian Catholic University, Sydney, Australia. michael.otim@gmail.com.
  • Orach CG; School of Public Health, Makerere University, Kampala, Uganda. cgorach@musph.ac.ug.
  • Cumming R; School of Public Health, University of Sydney, Sydney, Australia. robert.cumming@sydney.edu.au.
Hum Resour Health ; 13: 58, 2015 Jul 14.
Article em En | MEDLINE | ID: mdl-26169179
INTRODUCTION: Community health workers (CHWs) have been proposed as a means for bridging gaps in healthcare delivery in rural communities. Recent CHW programmes have been shown to improve child and neonatal health outcomes, and it is increasingly being suggested that paid CHWs become an integral part of health systems. Remuneration of CHWs can potentially effect their motivation and focus. Broadly, programmes follow a social, monetary or mixed market approach to remuneration. Conscious understanding of the differences, and of what each has to offer, is important in selecting the most appropriate approach according to the context. CASE DESCRIPTIONS: The objective of this review is to identify and examine different remuneration models of CHWs that have been utilized in large-scale sustained programmes to gain insight into the effect that remuneration has on the motivation and focus of CHWs. A MEDLINE search using Ovid SP was undertaken and data collected from secondary sources about CHW programmes in Iran, Ethiopia, India, Bangladesh and Nepal. Five main approaches were identified: part-time volunteer CHWs without regular financial incentives, volunteers that sell health-related merchandise, volunteers with financial incentives, paid full-time CHWs and a mixed model of paid and volunteer CHWs. DISCUSSION AND EVALUATION: Both volunteer and remunerated CHWs are potentially effective and can bring something to the health arena that the other may not. For example, well-trained, supervised volunteers and full-time CHWs who receive regular payment, or a combination of both, are more likely to engage the community in grass-roots health-related empowerment. Programmes that utilize minimal economic incentives to part-time CHWs tend to limit their focus, with financially incentivized activities becoming central. They can, however, improve outcomes in well-circumscribed areas. In order to maintain benefits from different approaches, there is a need to distinguish between CHWs that are trained and remunerated to be a part of an existing health system and those who, with little training, take on roles and are motivated by a range of contextual factors. Governments and planners can benefit from understanding the programme that can best be supported in their communities, thereby maximizing motivation and effectiveness.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: População Rural / Salários e Benefícios / Trabalho / Agentes Comunitários de Saúde / Países em Desenvolvimento / Remuneração / Motivação Tipo de estudo: Prognostic_studies Limite: Child / Humans / Newborn País/Região como assunto: Africa / Asia Idioma: En Revista: Hum Resour Health Ano de publicação: 2015 Tipo de documento: Article País de afiliação: Uganda

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: População Rural / Salários e Benefícios / Trabalho / Agentes Comunitários de Saúde / Países em Desenvolvimento / Remuneração / Motivação Tipo de estudo: Prognostic_studies Limite: Child / Humans / Newborn País/Região como assunto: Africa / Asia Idioma: En Revista: Hum Resour Health Ano de publicação: 2015 Tipo de documento: Article País de afiliação: Uganda