In many developing countries, the primary strategy for extending primary health care from facilities to underserved rural communities is community health workers. Systematic reviews of existing studies show that community health workers can be impactful in promoting positive health behavior and in providing basic curative and health services. The findings from reviews of randomized controlled trials of community health worker programs and interventions led by them, however, are mixed. A lack of incentives for community health workers to deliver timely and appropriate services has been highlighted as a key challenge in traditional programs. Specifically, community health work is often voluntary, but workers face competing opportunities such as paid-work or home production, that may lead them to devote less time to caregiving. This might help explain why strong impacts of community health worker programs come from studies in settings with high quality of supervision and support. Such a monitoring system may not be achievable in routine field situations. How to incorporate incentives to motivate community health workers in large-scale programs, and the impact that will have, are open questions.
Innovative approach to motivate community health workers
We assess a community health worker program in Uganda – the community health promoter program – where community health promoters operate as micro entrepreneurs earning an income on the sale of preventive and curative products to keep them motivated and active in the community. The underlying hypothesis is that these incentives – coupled with small financial incentives to encourage agents to register pregnant women and visit newborns within the first 48 hours of life – would motivate agents to actively provide Integrated Community Case Management and Maternal, Newborn and Child Health services. We believe the results are likely to advance a global conversation about how to best motivate community health workers to deliver timely and appropriate services.