The effect of payment and incentives on motivation and focus of community health workers: five case studies from low- and middle-income countries
The effect of payment and incentives on motivation and focus of community health workers: five case studies from low- and middle-income countries
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DOI：
10.1186/s12960-015-0051-1
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发表时间：
2015-07-14
影响因子：
4.5
通讯作者：
Cumming, Robert
中科院分区：
文献类型：
--
作者：
Singh, Debra;Negin, Joel;Cumming, Robert
前言：社区卫生工作者(CHW)已被提议作为弥补农村社区卫生保健服务差距的一种手段。最近的CHW方案被证明改善了儿童和新生儿的健康结果，而且越来越多的人建议，有偿CHW成为卫生系统的一个组成部分。社区卫生工作者的报酬可能会影响他们的积极性和专注度。总的来说，薪酬计划遵循一种社会、货币或混合市场的薪酬方式。有意识地了解不同之处以及各自提供的内容，对于根据情况选择最适当的方法是很重要的。案例说明：本次审查的目的是确定和审查在大规模可持续方案中使用的不同的社区卫生工作者薪酬模式，以深入了解薪酬对社区卫生工作者的动机和重点的影响。使用Ovid SP进行了MEDLINE搜索，并从二手来源收集了有关伊朗、埃塞俄比亚、印度、孟加拉国和尼泊尔的CHW方案的数据。研究确定了五种主要的方法：没有常规经济奖励的兼职志愿卫生工作者、销售健康相关商品的志愿者、有经济奖励的志愿者、有偿全职卫生工作者以及有偿和志愿卫生工作者的混合模式。讨论和评估：志愿和有偿卫生工作者都是潜在有效的，可以为卫生领域带来其他人可能无法带来的东西。例如，训练有素、受监督的志愿者和全职社区卫生工作者定期获得报酬，或两者兼而有之，更有可能让社区参与到与基层健康相关的赋权中。利用对兼职社区卫生工作者最低限度的经济激励的方案往往会限制他们的重点，财政激励的活动成为核心。然而，它们可以改善受限制地区的结果。为了保持不同方法带来的好处，有必要区分那些接受培训并获得报酬成为现有卫生系统一部分的社区卫生工作者和那些几乎没有接受过培训、担当角色并受到一系列背景因素激励的人。政府和规划者可以受益于了解其社区最能得到支持的方案，从而最大限度地提高积极性和有效性。
Introduction: Community health workers (CHWs) have been proposed as a means for bridging gaps in healthcare delivery in rural communities. Recent CHW programmes have been shown to improve child and neonatal health outcomes, and it is increasingly being suggested that paid CHWs become an integral part of health systems. Remuneration of CHWs can potentially effect their motivation and focus. Broadly, programmes follow a social, monetary or mixed market approach to remuneration. Conscious understanding of the differences, and of what each has to offer, is important in selecting the most appropriate approach according to the context.Case descriptions: The objective of this review is to identify and examine different remuneration models of CHWs that have been utilized in large-scale sustained programmes to gain insight into the effect that remuneration has on the motivation and focus of CHWs. A MEDLINE search using Ovid SP was undertaken and data collected from secondary sources about CHW programmes in Iran, Ethiopia, India, Bangladesh and Nepal. Five main approaches were identified: part-time volunteer CHWs without regular financial incentives, volunteers that sell health-related merchandise, volunteers with financial incentives, paid full-time CHWs and a mixed model of paid and volunteer CHWs.Discussion and evaluation: Both volunteer and remunerated CHWs are potentially effective and can bring something to the health arena that the other may not. For example, well-trained, supervised volunteers and full-time CHWs who receive regular payment, or a combination of both, are more likely to engage the community in grass-roots health-related empowerment. Programmes that utilize minimal economic incentives to part-time CHWs tend to limit their focus, with financially incentivized activities becoming central. They can, however, improve outcomes in well-circumscribed areas. In order to maintain benefits from different approaches, there is a need to distinguish between CHWs that are trained and remunerated to be a part of an existing health system and those who, with little training, take on roles and are motivated by a range of contextual factors. Governments and planners can benefit from understanding the programme that can best be supported in their communities, thereby maximizing motivation and effectiveness.