Table 4 Incentives and CHW motivation at the individual level
From: Community health workers at the dawn of a new era: 8. Incentives and remuneration
Findings | Policy and management prompts |
|---|---|
4.1 The coexistence of both altruism and the need to meet basic survival needs is an unavoidable aspect of the CHW motivation | How do CHWs describe the source of the altruism that keeps them engaged in their work? Is it a desire to be helpful to the community and neighbours in need? Is it religion? Cultural norms? Empathy for the suffering of others? Something else? How widely shared are these sources of altruism in the community? How does the CHW programme reinforce or undermine these sources of altruism? How do CHWs, programme managers, community members, or health facility staff perceive the relationship between altruism and personal benefit? How do CHWs try to manage any potential/perceived conflict? How can the incentives offered by the programme help them to sustain this balance? |
4.2 Intrinsic incentives alone are not sustainable over time but can be paired with effective extrinsic (material) incentives, which can take multiple forms | What are the economic needs and challenges for CHWs? What other kinds of work are available to them? Besides a salary or stipend, how else might the programme help to address some of their other material needs (training and certification opportunities, referrals for/preferential access to health, welfare, housing, or educational benefits, food parcels, transport money, airtime, etc.)? What ways of distributing these material benefits among the CHWs would be socially acceptable, avoid breeding competition, and not challenge altruistic motives? Seniority in the programme? Need? Level of performance? Something else? |
4.3 Though not sufficient by itself, intrinsic reward nonetheless often triggers CHW involvement and can be a necessary part of maintaining CHW motivation over time | Do the CHWs recruited for a programme have some personal connection to the health problem addressed or some other altruistic motivation for working as CHWs? What was their trigger for getting involved? Have they developed intrinsic motivations over time? |