Remuneration and Recruitment of Study Participants for AD Cohort Studies From the General Public and From Minority Communities.

INTRODUCTION: Offering remuneration for participation in studies of aging and Alzheimer Disease (AD) may improve recruitment, particularly among minoritized and low-income groups. But remuneration may also raise ethical problems and reduce altruistic motivations for participation. METHODS: A nationally representative sample of Americans (N=2030) with large (N=500) Black and Hispanic oversamples was asked about willingness to participate in a longitudinal AD cohort study after random assignment of remuneration ($0, $50/visit, $100/visit). Respondents were then asked about their perceived burden, risks, and societal contribution from participation. RESULTS: An offer of remuneration increased willingness to participate, with no difference between $50 and $100. The increase was similar across racial, ethnic, and income groups. Remuneration did not affect perceived risks or altruistic benefits. Compensation caused Whites and Hispanics, but not Blacks, to lower the perceived burden. DISCUSSION: Modest levels of remuneration are likely to improve recruitment to AD research studies without causing collateral ethical or motivation problems. Remuneration does not differentially enhance minority recruitment.

Increasing capitation in mixed remuneration schemes: Effects on service provision and process quality of care.

Many health systems apply mixed remuneration schemes for general practitioners, but little is known about the effects on service provision of changing the relative mix of fee for services and capitation. We apply difference-in-differences analyses to evaluate a reform that effectively reversed the mix between fee for services and capitation from 80/20 to 20/80 for patients with type 2 diabetes. Our results show reductions in provision of both the contact services that became capitated and in other non-capitated (still-billable) services. Reduced provision also occurred for guideline-recommended process quality services. We find that the effects are mainly driven by patients with co-morbidities and by general practitioners with high income, relatively many diabetes patients, and solo practitioners. Thus, increasing capitation in a mixed remuneration schemes appears to reduce service provision for patients with type 2 diabetes monitored in general practice with a risk of unwanted quality effects.

Health expenditure: how much is spent on health and care worker remuneration? An analysis of 33 low- and middle-income African countries.

OBJECTIVES: To assess the amount spent on health and care workforce (HCW) remuneration in the African countries, its importance as a proportion of country expenditure on health, and government involvement as a funding source. METHODS: Calculations are based on country-produced disaggregated health accounts data from 33 low- and middle-income African countries, disaggregated wherever possible by income and subregional economic group. RESULTS: Per capita expenditure HCW remuneration averaged US$ 38, or 29% of country health expenditure, mainly coming from domestic public sources (three-fifths). Comparable were the contributions from domestic private sources and external aid, measured at around one-fifth each-23% and 17%, respectively. Spending on HCW remuneration was uneven across the 33 countries, spanning from US$ 3 per capita in Burundi to US$ 295 in South Africa. West African countries, particularly members of the West African Economic and Monetary Union (WAEMU), were lower spenders than countries in the Southern African Development Community (SADC), both in terms of the share of country health expenditure and in terms of government efforts/participation. By income group, HCW remuneration accounted for a quarter of country health expenditure in low-income countries, compared to a third in middle-income countries. Furthermore, an average 55% of government health expenditure is spent on HCW remuneration, across all countries. It was not possible to assess the impact of fragile and vulnerable countries, nor could we draw statistics by type of health occupation. CONCLUSIONS: The results clearly show that the remuneration of the health and care workforce is an important part of government health spending, with half (55%) of government health spending on average devoted to it. Comparing HCW expenditure components allows for identifying stable sources, volatile sources, and their effects on HCW investments over time. Such stocktaking is important, so that countries, WHO, and other relevant agencies can inform necessary policy changes.

Excessive workload and insufficient night-shift remuneration are key elements of dissatisfaction at work for French neonatologists.

AIM: Neonatologists are exposed to ethical issues and unplanned emergencies that require 24-h in-house coverage. These elements may affect quality of life at work, which we surveyed. METHODS: This was a self-administered, voluntary and anonymous cross-sectional survey of French neonatologists. An online questionnaire was sent to members of the French Society of Neonatology from June to October 2022. RESULTS: Of approximately 1500 possible responses, 721 were analysed, with a response rate of 48%. Respondents were mostly women (77%), aged 35-50 years (50%), and hospital practitioners (63%). Reported weekly working time was over 50 h for 80%. Among the 650 neonatologists with on-call duty, 47% worked ≥5 shifts per month. For 80% of practitioners, on-call duty was perceived to have a negative impact on personal life; 49% indicated having sleep disorders. The mean satisfaction score at work was 5.7 ± 1.7 on a scale of 0-10. The main reasons for dissatisfaction were excessive working hours and insufficient remuneration for on-call duty. CONCLUSION: This first evaluation of the quality of life at work of French neonatologists showed high workload. The working conditions and specificities of NICU activity may have significant consequences for their mental health.

Involving people with lived experience of spinal cord injury in research: a policy for consumer remuneration.

To ensure that research outcomes are relevant and meet the needs of the spinal cord jury (SCI) community, it is essential that people with lived experience of SCI ('consumers') are actively involved in all stages of the research process. One of the goals of the Spinal Research Institute (SRI) ( www.thesri.org ) is to facilitate this active engagement of consumers in research. In order to support consumer involvement, appropriate resources, including remuneration, need to be in place. This paper sets out the process undertaken by the SRI to develop a Policy for Consumer Remuneration. It addresses the rationale for creating a policy, the resources used and shares the model that defines the levels of consumer engagement and associated remuneration. The SRI Policy for Consumer Remuneration sets a standard for the SCI research field, which can serve as a model for Australia and as a template for other countries.

General practice undergraduate and vocational training: ambulatory teaching and trainers' curriculum and remuneration - a cross-sectional study among 30 member countries of WONCA Europe.

BACKGROUND: After a long phase without any propositions for real ambulatory training inside general practitioners' offices, general practice (GP) vocational training has begun to appear progressively and has been integrated into undergraduate medical programmes. The aim of this study was to provide an overview of GP vocational training and GP trainers in member countries of the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA) Europe. METHOD: We carried out this cross-sectional study between September 2018 and March 2020. The participants responded to a questionnaire in real-life conversations, video conferences or e-mail exchanges. The respondents included GP trainers, teachers and general practitioners involved in the GP curriculum recruited during European GP congresses. RESULTS: Representatives from 30 out of 45 WONCA Europe member countries responded to the questionnaire. Based on their responses, there is a well-established period for GP internships in undergraduate medical programmes, but with varying lengths. The programmes for some countries offer an internship after students graduate from medical school but before GP specialisation to ensure the career choice of the trainees. After specialisation, private practice GP internships are offered; however, in-hospital GP internships are more common. GP trainees no longer have a passive role during their internships. GP trainers are selected based on specific criteria and in countries, they have to follow some teacher training programmes. In addition to income from medical appointments carried out by GP trainees, GP trainers from some countries receive additional remuneration from various organisations. CONCLUSION: This study collected information on how undergraduate and postgraduate medical students are exposed to GP, how GP training is organised and the actual status of GP trainers among WONCA Europe member countries. Our exploration of GP training provides an update of the data collected by Isabel Santos and Vitor Ramos in the 1990s and describes some specificities that can inspire other organisations to prepare young, highly qualified general practitioners.

[Remuneration for HPV Vaccination Service in Germany - A Relevant Factor for the HPV Immunization Rate?] / Vergütung der HPV-Impfungsleistung in Deutschland ­ ein relevanter Einflussfaktor auf die HPV-Impfrate?

Although HPV vaccination has been recommended in Germany since 2007, vaccination rates for completed HPV vaccination series are still low and there are significant regional differences. Remuneration for vaccination services is being discussed as one of the factors influencing the HPV vaccination rate in Germany. However, data on remuneration of HPV vaccination services show significant differences regarding the amount and way of remuneration depending on the Statutory Health Insurance region in Germany which are not obviously associated with the regional vaccination rate. This suggests that currently the remuneration of HPV vaccination services does not play a significant role in HPV immunization rates. In order to increase HPV vaccination rates, other interventions that have been shown to be effective for this purpose should therefore be prioritized, with policy supporting a comprehensive approach through legislation, the creation of structural frameworks and the provision of resources.

[The attitude and willingness to blood donorship among student youth of metropolis].

The shortage of blood donors is significant problem of Russian health care. The potential of involving new blood donors can be found, in particular, in activities on popularization of blood donor practices among students. The empirical study was carried out in 2022 to determine attitude of students and their willingness to take part in practices of blood donorship. The online survey of university students was implemented based on representative quota sampling of 1 135 respondents with gender, educational status and place of residence controlled. The results demonstrate complicated picture of motives and factors predetermining personal strategies and experiences of participation in blood donorship. The contradiction between positive attitude to blood donorship declared by students and passive behavioral practices was revealed. The motivation for blood donorship, mainly individual, is assessed as personal choice of student. The motivation based on altruism and desire to provide effective help is determinative. However, such obstacles of implementing blood donorship practices as insufficient information about possibilities and consequences of blood donorship, distrust of health care system, fear of blood collection procedure, lack of remuneration.

Demand Response Contextual Remuneration of Prosumers with Distributed Storage.

Prosumers are emerging in the power and energy market to provide load flexibility to smooth the use of distributed generation. The volatile behavior increases the production prediction complexity, and the demand side must take a step forward to participate in demand response events triggered by a community manager. If balance is achieved, the participants should be compensated for the discomfort caused. The authors in this paper propose a methodology to optimally manage a community, with a focus on the remuneration of community members for the provided flexibility. Four approaches were compared and evaluated, considering contextual tariffs. The obtained results show that it was possible to improve the fairness of the remuneration, which is an incentive and compensation for the loss of comfort. The single fair remuneration approach was more beneficial to the community manager, since the total remuneration was lower than the remaining approaches (163.81 m.u. in case study 3). From the prosumers' side, considering a clustering method was more advantageous, since higher remuneration was distributed for the flexibility provided (196.27 m.u. in case study 3).

[Outsourcing of nursing staff costs in psychiatry? : A secondary data analysis of possible effects on the remuneration system in psychiatry]. / Ausgliederung der Pflegekosten in der Psychiatrie? : Eine Sekundärdatenanalyse möglicher Auswirkungen auf das PEPP-System.

BACKGROUND: Nursing staff were excluded from the German DRG system for somatic hospital treatment and will be funded separately in the future. In psychiatry and psychosomatic medicine, binding personnel requirements have been defined but there has been no regulation of how these personnel requirements are adequately financed. OBJECTIVE: The objective of this study was to analyze the costs of inpatient psychiatry and psychosomatic medicine and to evaluate possible effects of funding nursing staff separately. MATERIAL AND METHODS: This analysis is based on aggregated daily treatment costs of selected hospitals (data year 2018), which annually submit their performance and cost data to the Institute for the Hospital Remuneration System (InEK) for the empirical further development of the remuneration system. RESULTS: Nursing staff represent the largest cost factor in inpatient psychiatry and psychosomatic medicine. Excluding nursing staff drastically reduces the variance of psychiatric DRG renumeration and even exceeds its proportion of the total costs. After outsourcing nursing costs, psychiatric DRGs achieve only a very limited cost separation. CONCLUSION: The binding personnel requirements necessitate adequate financing of nursing staff. This raises the debate about the further development of psychiatric remuneration. The question arises as to whether the effort associated with using the psychiatric DRG system justifies its usefulness as an instrument for budgeting when core functions such as cost separation are only given to a limited extent. Alternative approaches to budgeting should also be examined for putting costs and benefits in a better ratio.

Hiring intentions and remuneration of veterinary practitioners in western Canada.

All private veterinary practices in western Canada (N = 1333) were surveyed during the SARS-CoV-2 pandemic (January to November 2020) to generate data on the demographics of the profession, and to quantify past and present hiring intentions (demand) as well as remuneration for veterinary associates. The response rate was 39.5% (526/1333), 186 of which had hired at least one full- (FT) or part-time (PT) associate within the 12-month period preceding the completion of the survey. When extrapolated to the practices that did not respond (nonresponders), as many as 471 practices may have hired an associate within the previous 12 mo. The median (mean) annual remuneration paid to FT associates was $90 000 ($91 730). The median number of months it took to hire an associate did not vary by province (P = 0.52); however, it did vary by practice type (P <0.0001): companion animal practice, 3.0 mo; food animal practice, 8.0 mo; and mixed animal practice, 12.0 mo. At the time of the survey, 232 of the 526 (44.1%) responding practices were currently seeking to fill 281 vacancies, representing 274 full-time equivalents (FTE). If extrapolated to the nonresponders, the total number of vacant FTE positions could have been as high as 694. The median (mean) annual wage offered for a FT associate was $87 500 ($88 940), which did not differ by province (P = 0.14) or practice type (P = 0.22). The results of this study support anecdotal reports of a shortage of private veterinary practitioners in western Canada.

Intentions d'embauche et rémunération des vétérinaires praticiens dans l'Ouest canadien. Tous les cabinets vétérinaires privés de l'Ouest canadien (N = 1333) ont été interrogés pendant la pandémie de SARS-CoV-2 (janvier à novembre 2020) afin de générer des données sur la démographie de la profession et de quantifier les intentions d'embauche passées et présentes (demande) ainsi que rémunération des associés vétérinaires. Le taux de réponse était de 39,5 % (526/1333), dont 186 avaient embauché au moins un associé à temps plein (FT) ou à temps partiel (PT) au cours de la période de 12 mois précédant la fin de l'enquête. Lorsqu'ils sont extrapolés aux pratiques qui n'ont pas répondu (non-répondants), jusqu'à 471 pratiques peuvent avoir embauché un associé au cours des 12 derniers mois. La rémunération annuelle médiane (moyenne) versée aux associés de FT était de 90 000 $ (91 730 $). Le nombre de mois qu'il a fallu pour embaucher un associé ne variait pas selon la province (P = 0,52); cependant, elle variait selon le type de pratique (P <0,0001) : pratique des animaux de compagnie, 3,0 mois; pratique des animaux destinés à l'alimentation, 8,0 mois; et pratique animale mixte, 12,0 mois. Au moment de l'enquête, 232 des 526 cabinets répondants (44,1 %) cherchaient actuellement à pourvoir 281 postes vacants, représentant 274 équivalents temps plein (ETP). Si extrapolé aux non-répondants, le nombre total de postes vacants en ETP aurait pu atteindre 694. Le salaire annuel médian (moyen) offert pour un associé à temps plein était de 87 500 $ (88 940 $), ce qui ne différait pas selon la province (P = 0,14) ou type de pratique (P = 0,22). Les résultats de cette étude appuient les rapports anecdotiques d'une pénurie de vétérinaires praticiens privés dans l'Ouest canadien.(Traduit par Dr Serge Messier).

[The comparative analysis of professional standards of specialists with higher and secondary medical professional education].

In 2020, the Mintrud of Russia approved a number of professional standards for specialists with secondary professional medical education. The implementation of professional standards is called to actualize outdated normative base concerning functions of medical workers, including assurance of separation of labor functions and actions of physicians and medical nurses, facilitation of development of job descriptions, and minimizing number of conflicts that occur during process of work activities at personnel functions crossing. The medical organization, focusing on requirements established by professional standards, can more competently develop personnel policy, make timely changes in staff list, establish progressive remuneration system. In this regard, it is useful to learn to what extent approved professional standards facilitate solution of practical problems of medical organizations.The article presents results of comparative analysis of three pairs of professional standards for paramedical personnel and specialists with higher education in comparable specialties. Certain contradictions and inaccuracies were esnablished too.

Certain aspects of management of health preservation system.

The trends in development of National health care in Russia are considered. The need in formation of intersectorial system of management of health protection activities is established with priority of preventive direction, including mental prevention, based on systematic observation and participation of both sick and healthy people. The system goal was determined - to improve population health. The main tasks and principles of system functioning are formulated. The reasonableness of application of mechanisms of motivating and stimulating all subjects of health protection system in order to increase their interest, is indicated as one of directions of organizing and introducing intersectorial health protection system. The basic principles of development and implementation of incentive systems of remuneration were formulated. The attention is focused on such aspect related to management of health protection system as legal support. The review of sources of law in the field of health protection revealed that all subjects have duties, and everyone has responsibilities, except citizens and insured persons. To resolve this problem, it was proposed to conclude agreement between the parties, indicating rights and obligations of both parties and responsibility for violation of contractual obligations. The structure is proposed, the main principles of health protection system management are described, designed to provide real shift in achieving settled goals.

The current state of the platelet supply in the US and proposed options to decrease the risk of critical shortages.

Due to circumstances such as increased demand and an aging donor pool, the likelihood of critical platelet shortages is increasing. The platelet supply could be improved through the expansion of the donor pool, the identification and sustained utilization of high-quality donors, and changes in component processing and storage that result in a longer platelet shelf-life. Refrigerated platelets, stored at 1° to 6°C, have the potential to improve patient safety by decreasing the risk of bacterial contamination while concurrently allowing for a longer storage period (eg, 14 days) and improved hemostatic effectiveness in actively bleeding patients. An approach utilizing remuneration of apheresis platelet donors combined with pathogen reduction of the platelet components could be used as a means to increase the donor pool and identify and sustain safe, reliable, high-quality donors. Remuneration might provide an incentive for underutilized populations (eg, individuals <30 years old) to enter the apheresis platelet donor population resulting in a significant expansion of the platelet donor pool. Over time, approaches such as the use of refrigerated platelets, platelet donor remuneration, and the application of pathogen reduction technology, might serve to attract a large, reliable, and safe donor base that provides platelet collections with high yields, longer shelf-lives and, excellent hemostatic function.

Stopping exploitation: Properly remunerating healthcare workers for risk in the COVID-19 pandemic.

We argue that we should provide extra payment not only for extra time worked but also for the extra risks healthcare workers (and those working in healthcare settings) incur while caring for COVID-19 patients-and more generally when caring for patients poses them at significantly higher risks than normal. We argue that the extra payment is warranted regardless of whether healthcare workers have a professional obligation to provide such risky healthcare. Payment for risk would meet four essential ethical requirements. First, assuming healthcare workers do not have a professional obligation to take on themselves the risks, payments in the form of incentives would preserve autonomy in deciding what risks to take on oneself. Second, even assuming that healthcare workers do have a professional obligation to take on themselves the risks, payments for risk would create fair working conditions by avoiding exploitation. Third, payments for risk would make it more likely that public healthcare systems can discharge their institutional responsibility to provide healthcare in circumstances where healthcare workers may otherwise (perhaps legitimately) opt out. Fourth, payments for risk would guarantee an efficient healthcare system in pandemic situations. Finally, we address two likely objections that some might raise against our proposal, particularly with regard to incentives, namely that such payments or incentives can themselves be coercive and that they represent a form of undue inducement.

Community health workers at the dawn of a new era: 8. Incentives and remuneration.

BACKGROUND: This is the eighth in our series of 11 papers on "CHWs at the Dawn of a New Era". Community health worker (CHW) incentives and remuneration are core issues that affect the performance of individual CHWs and the performance of the overall CHW programme. A better understanding of what motivates CHWs and a stronger awareness of the social justice dimensions of remuneration are essential in order to build stronger CHW programmes and to support the professionalization of the CHW workforce. METHODS: We provide examples of incentives that have been provided to CHWs and identify factors that motivate and demotivate CHWs. We developed our findings in this paper by synthesizing the findings of a recent review of CHW motivation and incentives in a wide variety of CHW programmes with detailed case study data about CHW compensation and incentives in 29 national CHW programmes. RESULTS: Incentives can be direct or indirect, and they can be complementary/demand-side incentives. Direct incentives can be financial or nonfinancial. Indirect incentives can be available through the health system or from the community, as can complementary, demand-side incentives. Motivation is sustained when CHWs feel they are a valued member of the health system and have a clear role and set of responsibilities within it. A sense of the "do-ability" of the CHW role is critical in maintaining CHW motivation. CHWs are best motivated by work that provides opportunities for personal growth and professional development, irrespective of the direct remuneration and technical skills obtained. Working and social relationships among CHWs themselves and between CHWs and other healthcare professionals and community members strongly shape CHW motivation. CONCLUSION: Our findings support the recent guidelines for CHWs released by WHO in 2018 that call for CHWs to receive a financial package that corresponds to their job demands, complexity, number of hours worked, training, and the roles they undertake. The guidelines also call for written agreements that specify the CHW's role and responsibilities, working conditions, remuneration, and workers' rights.

Fighting for America's Paradise: The Struggle against Structural Racism.

Structural racism is a fundamental cause of racial inequities in health in the United States. Structural racism is manifested in inequality in the criminal justice system; de facto segregation in education, health care, and housing; and ineffective and disproportionately violent policing and economic disenfranchisement in communities of color. The inequality that Black people and communities of color face is the direct result of centuries of public policy that made Black and Brown skin a liability. The United States is now in an unprecedented moment in its history with a new administration that explicitly states, "The moment has come for our nation to deal with systemic racism . . . and to deal with the denial of the promise of this nation-to so many." The opportunities for creating innovative and bold policy must reflect the urgency of the moment and seek to dismantle the systems of oppression that have for far too long left the American promise unfulfilled. The policy suggestions made by the authors of this article speak to the structural targets needed for dismantling some of the many manifestations of structural racism so as to achieve health equity.

Stirring the pot: Switching from blended fee-for-service to blended capitation models of physician remuneration.

In Canada's most populous province, Ontario, family physicians may choose between the blended fee-for-service (Family Health Group [FHG]) and blended capitation (Family Health Organization [FHO] payment models). Both models incentivize physicians to provide after-hours (AH) and comprehensive care, but FHO physicians receive a capitation payment per enrolled patient adjusted for age and sex, plus a reduced fee-for-service while FHG physicians are paid by fee-for-service. We develop a theoretical model of physician labor supply with multitasking to predict their behavior under FHG and FHO, and estimable equations are derived to test the predictions empirically. Using health administrative data from 2006 to 2014 and a two-stage estimation strategy, we study the impact of switching from FHG to FHO on the production of a capitated basket of services, after-hours services and nonincentivized services. Our results reveal that switching from the FHG to FHO reduces the production of capitated services to enrolled patients and services to nonenrolled patients by 15% and 5% per annum and increases the production of after-hours and nonincentivized services by 8% and 15% per annum.

Payment in challenge studies: ethics, attitudes and a new payment for risk model.

Controlled Human Infection Model (CHIM) research involves the infection of otherwise healthy participants with disease often for the sake of vaccine development. The COVID-19 pandemic has emphasised the urgency of enhancing CHIM research capability and the importance of having clear ethical guidance for their conduct. The payment of CHIM participants is a controversial issue involving stakeholders across ethics, medicine and policymaking with allegations circulating suggesting exploitation, coercion and other violations of ethical principles. There are multiple approaches to payment: reimbursement, wage payment and unlimited payment. We introduce a new Payment for Risk Model, which involves paying for time, pain and inconvenience and for risk associated with participation. We give philosophical arguments based on utility, fairness and avoidance of exploitation to support this. We also examine a cross-section of the UK public and CHIM experts. We found that CHIM participants are currently paid variable amounts. A representative sample of the UK public believes CHIM participants should be paid approximately triple the UK minimum wage and should be paid for the risk they endure throughout participation. CHIM experts believe CHIM participants should be paid more than double the UK minimum wage but are divided on the payment for risk. The Payment for Risk Model allows risk and pain to be accounted for in payment and could be used to determine ethically justifiable payment for CHIM participants.Although many research guidelines warn against paying large amounts or paying for risk, our empirical findings provide empirical support to the growing number of ethical arguments challenging this status quo. We close by suggesting two ways (value of statistical life or consistency with risk in other employment) by which payment for risk could be calculated.

Remuneration systems of community health workers in India and promoted maternal health outcomes: a cross-sectional study.

BACKGROUND: This study assessed the association of remuneration systems of paid-for-performance Accredited Social Health Activists (ASHAs) and salaried Anganwadi workers (AWWs) on seven maternal health outcomes in four states in India: Andhra Pradesh (AP), Chhattisgarh, Odisha (Orissa), and Uttar Pradesh (UP). METHODS: The cross-sectional study surveyed mothers of children aged 6-23 months. A total of 3455 mothers were selected via multistage cluster sampling. The seven health outcomes related to the community health worker (CHW) visits were: institutional delivery, complete immunization, exclusive breastfeeding for six months, timely introduction of complementary feeding, continued breastfeeding during child's illness, handwashing, and awareness of Nutrition and Health Days (NHDs). RESULTS: The results varied by state. Mothers who received ASHA visits were significantly less likely to have an institutional delivery, timely introduction of complementary feeding, awareness of Nutrition and Health Days (NHDs), proper handwashing, and exclusive breastfeeding for the first six months in at least one of the four states. Conversely, AWW's home visits were positively predictive of the following health outcomes in certain states: complete immunization for index child, continued breastfeeding during the child's illness, handwashing, and awareness of NHDs. CONCLUSIONS: ASHAs' home visits were not more strongly associated with health outcomes for which they were paid than outcomes for which they were unpaid. AWWs' home visits were positively associated with awareness of NHDs, and associations varied for other recommended health behaviors. Further research could elucidate the causes for successes and failures of CHW programs in different states of India.