Financial incentive for community health workers, a necessity for achieving universal health coverage: integrated literature review

Abstract

Community health workers (CHWs) are vital to achieve universal health coverage (UHC). They have been identified as effective workforce to improve access to primary health care particularly for underserved and hard to reach populations. Lack of appropriate incentives, with resulting high rates of turnover are common challenges in large-scale CHW program. Debates about paying community health workers typically focus on the trade-offs between reliance on volunteerism underpinned by intrinsic motivation of volunteers and the need to recognise and remunerate work fairly. Financial payment for CHWs will also help in increased employment, and women’s economic empowerment, tackling gender-based inequities, as seventy percent of CHWs globally are women. This study reviewed existing literature- published peer reviewed articles and grey literatures on financial incentives for community health workers and program considerations for effective implementation. Synthesis from the relevant studies revealed four relevant themes: need for financial incentives, categories of financial incentives, funding mechanisms for financial incentives and program considerations for effective implementation of financial incentives. The study provides program considerations for effective implementation of financial incentive for community health workers. There is need for countries to review their community health worker program design and establish enabling policy environment and implementation mechanisms for realistic and appropriate financial incentives for the community health workers based on their workload, responsibilities, and local context. Appropriate tools should be used to model the community health workers working hours which will guide in determining fair and commensurate renumeration and effective monitoring system established.