Documenting Community Health Worker Compensation Schemes and Their Perceived Effectiveness in Seven sub-Saharan African Countries: A Qualitative Study

Alyssa L. Davis; Lola Flomen; Jehan Ahmed; Djibrilla Maiga Arouna; Amos Asiedu; Maman Bacharou Badamassi; Ousmane Badolo; Moumouni Bonkoungou; Ciro Franco; Zachariah Jezman; Victoria Kalota; Beh Kamate; Daniel Koko; John Munthali; Raphael Ntumy; Patrick Sichalwe; Oumar Yattara

doi:10.9745/GHSP-D-24-00008

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TABLE 1.

Key Informants Interviewed Across Seven sub-Saharan African Countries

	Benin	Burkina Faso	Ghana	Malawi	Mali	Niger	Zambia	Total
Government	2	3	1	5	10	13	3	37
Nongovernmental organization	2	0	1	2	2	0	3	10
United Nations agencies	1	0	0	0	1	1	0	3
Donor	0	0	1	1	0	1	1	4
Private-sector organization	0	1	0	0	0	0	0	1
Community health worker	0	0	0	8	2	3	0	13
Total	5	4	3	16	15	18	7	68

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TABLE 2.

Overview of Community Health Worker Financial Compensation Schemes in Seven sub-Saharan African Countries

	Benin		Burkina Faso	Ghana		Malawi		Mali	Niger		Zambia
	Agents de Santé Communautaire Qualifié	Relais Communautaire	Agents de Santé à Base Communautaire	Community Health Officer	Community Based Volunteer	Health Surveillance Assistant	Community Health Volunteer	Agents de Santé Communautaire	Agents de Santé Communautaire	Relais Communautaire	Community Health Assistant	Community Based Volunteer
Officially full time or part time	Full time	Part time	Part time	Full time	Part time	Full time	Part time	Full time	Full time	Part time	Full time	Part time
Employed or volunteer	Employed	Volunteer	Volunteer	Employed	Volunteer	Employed	Volunteer	Employed	Employed	Volunteer	Employed	Volunteer
Length of pre-service training and any degree requirements	9th grade certificate or equivalent and paramedical training	∼10 days, depending on partner priorities and disease burdens	19 days	2 year nursing degree + 2 weeks training	∼5 days	12 weeks	Varying lengths depending on partner support	22 days	6 months	2 weeks	1 year	Varying lengths depending on partner support
Financial compensation
Salary,^a US$	∼300/month			∼130-160/month		∼175 – 280/month		∼ 70/month	∼80/month		∼380/month
Stipend,^a US$		∼75/month (performance based)	∼30/month							∼30/month		<20 hours per week ∼30/month
Incentive amounts			Standardized		Various		Standardized			Various		Standardized
Payment mode	Bank account transfer	Mobile money transfer	Mobile money transfer	Bank account transfer	Cash	Bank account transfer	Cash	Various partner supported modes	Various partner supported modes	Mobile money transfer	Bank account transfer	Cash and Mobile credit
Government supported	X	X	X	X		X			X		X
Donor supported		X	X	X	X	X	X	X	X	X	X	X
Minimum wage alignment	X	X		X		X		X	X		X
Functions and services
Community mobilization	X	X	X	X	X	X	X	X	X	X	X	X
Health promotion	X	X	X	X	X	X	X	X	X	X	X	X
iCCM services	X	Referral only	If >5 km from health facility	Facility-based IMNCI	Referral only	X	Referral only	X		If >5 km from health facility		X
Other services	X	One Health Package	Ad hoc campaigns	X	Ad hoc campaigns	X	Ad hoc campaigns	X	X	X	X	Ad hoc campaigns
Catchment area
CHW to population ratio	At least 1/arrondissement	1/150–200 households	1/1,000 people	1/5,000 people	Undefined	1/1,000 people	Undefined	1/100–700 people	1/10,000 people	1/5,000 people	1/health post	1/250–500 households
Individual community		X	X		X		X	Based on population density		X		X
Multiple communities	X			X		X		Based on population density	X		X
Health facility relationship
Facility based	X			X		X			X		X
Supervised by health facility staff	X	X	X	X	X	X	X	X	X	X	X	X

Abbreviations: CHW, community health worker; iCCM, integrated community case management; IMNCI, Integrated Management of Newborn and Child Illnesses.
↵a Equivalent amounts calculated as of June 2023.