The effect of payment and incentives on motivation and focus of community health workers: five case studies from low- and middle-income countries

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…