Best practices for designing interventions to improve health worker performance in low- and middle-income countries

Effective health worker (HW) performance is essential for high-quality healthcare. Yet, many low- and middle-income countries rely on HW performance improvement (HWPI) interventions that often yield modest results, such as stand-alone in-service HW training. This viewpoint identifies more effective HWPI interventions, such as group problem-solving. To encourage use of these approaches, we propose definitions of more effective HWPI interventions and what constitutes a high-quality HWPI investment (i.e. support for a particular intervention in a given context). We examine intervention effectiveness from a large systematic review as part of these definitions. We also present 13 best practices for intervention design and show how HWPI investments could be developed to achieve larger, sustained improvements in HW performance in real-world settings. Some best practices include a minimum expected effectiveness of 15 percentage points above baseline performance and basing the design on a situational analysis. We have formatted the best practices into a simple checklist tool for countries to inform their HWPI actions, including those proposed in grant applications, and for donors when reviewing grants. Our overarching goal is to optimise intervention effectiveness and improve HW performance and healthcare quality.