Documenting Community Health Worker Compensation Schemes and Their Perceived Effectiveness in Seven sub-Saharan...

Area of Science:

• Global Health
• Health Systems Strengthening
• Human Resources for Health

Background:

• Community health worker (CHW) incentives and remuneration are critical for program performance, yet implementation details of financial compensation schemes in sub-Saharan Africa remain underdocumented.
• Understanding stakeholder perceptions of CHW compensation is vital for optimizing health service delivery and worker retention.

Purpose of the Study:

• To document CHW financial compensation schemes in sub-Saharan Africa.
• To assess CHW, government, and stakeholder perceptions of scheme effectiveness.
• To identify lessons learned for effective CHW compensation.

Main Methods:

• Conducted 68 semistructured interviews with key informants across 7 sub-Saharan African countries.
• Employed thematic analysis of coded interview data.
• Reviewed relevant country documentation to contextualize findings.

Main Results:

• Compensation schemes perceived as effective feature regular, consistent payments of sufficient amounts, supporting performance and continuity.
• Employed CHW status and government payroll mechanisms were associated with higher perceived effectiveness.
• Volunteer CHW compensation schemes showed varied delivery mechanisms and lower perceived effectiveness.

Conclusions:

• Policymakers should design CHW compensation schemes aligned with national health delivery models, considering factors influencing effectiveness.
• Systematic documentation of volunteer CHW roles and time commitment is needed for fair compensation, aligning with WHO guidelines.
• Effective implementation requires government leadership, coordination, community engagement, and sustainable financing.