Table 7 Change over time in CHW motivations
From: Community health workers at the dawn of a new era: 8. Incentives and remuneration
Findings | Policy and management prompts |
|---|---|
7.1 At the individual level, the effects of incentives change over time as do the motivations, needs, and capacities of individual CHWs | Have the incentives offered to CHWs remained the same over a long period of time? If so, is there reason to believe that their motivating impact may have lessened? If so, should the incentive be increased, or should it be complemented with other forms of incentives? Do the needs and interests of individual CHWs change significantly over time? As they get older and have families, do they report that previous incentives are less relevant and alternative incentives potentially more effective? If considering varying incentives over time, is there a way to do this that involves sufficient consultation with CHWs as well as equitable and transparent processes and policies for these changes? |
7.2 At the programme level, it is important both to understand policy development and programme implementation as a process and to recognize the importance of feedback and participation in the cycle of programme design, implementation, and evaluation | What kind of planning and consultation went into the design of incentives at the beginning of the CHW programme? Were CHWs consulted? If so, how? If not, why not? What do CHWs feel about the current, formal incentive package? What other elements of their work motivate (or demotivate) them to perform and remain in their post? How do they interpret changes in the incentives offered by the programme over time, and how does this shape their expectations about future incentives? Are there opportunities for CHW feedback to be solicited and fed into ongoing management, evaluation, and programme design cycles? Does this consultation process take CHW concerns into account, and do CHWs perceive the process to be fair and responsive? |
7.3 At the contextual level, changes in social, cultural, political, economic, health systems, epidemiological, and demographic contexts also affect CHW motivation, and these need to be accounted for in incentive packages | Since the initial design of the CHW programme and its incentives, what has changed in the broader context that might impact on these incentives? Have the priority diseases changed? Have the epidemiological priorities or demographics of the local setting shifted? Have political changes or social conflicts emerged? Have economic opportunities flourished or floundered? Has the health system undergone any significant restructuring that might change how certain services or roles are perceived? Has disease-related stigma abated or intensified? |