PT - JOURNAL ARTICLE AU - Davis, Alyssa L. AU - Flomen, Lola AU - Ahmed, Jehan AU - Arouna, Djibrilla Maiga AU - Asiedu, Amos AU - Badamassi, Maman Bacharou AU - Badolo, Ousmane AU - Bonkoungou, Moumouni AU - Franco, Ciro AU - Jezman, Zachariah AU - Kalota, Victoria AU - Kamate, Beh AU - Koko, Daniel AU - Munthali, John AU - Ntumy, Raphael AU - Sichalwe, Patrick AU - Yattara, Oumar TI - Documenting Community Health Worker Compensation Schemes and Their Perceived Effectiveness in Seven sub-Saharan African Countries: A Qualitative Study AID - 10.9745/GHSP-D-24-00008 DP - 2024 Jun 27 TA - Global Health: Science and Practice PG - e2400008 VI - 12 IP - 3 4099 - http://www.ghspjournal.org/content/12/3/e2400008.short 4100 - http://www.ghspjournal.org/content/12/3/e2400008.full SO - GLOB HEALTH SCI PRACT2024 Jun 27; 12 AB - Key FindingsFinancial compensation schemes and service delivery models varied greatly across Benin, Burkina Faso, Ghana, Malawi, Mali, Niger, and Zambia, with each country engaging community health workers (CHWs) with different responsibilities, catchment areas, and relationships to health facilities.The majority of the countries used a dual-cadre service delivery model in which CHWs who were at least partially based at facilities were considered to be full-time employees and paid a salary, while CHWs who were based in communities were considered part-time volunteers and given a stipend or activity-based incentive.Key informants described several challenges with compensation schemes for volunteer status CHWs, including irregular payments, inconsistent distribution, and insufficient amount of compensation, which led to demotivation and attrition of CHWs and, in turn, negatively affected health service continuity.Key ImplicationsPolicymakers should consider these findings in the design of compensation schemes for CHWs engaged in routine, continuous health service delivery within the context of their country’s health service delivery model.Greater sensitization of the 2018 World Health Organization recommendation on CHW compensation, along with practical guidance on how to assess CHW responsibilities, workload, and training, may be needed to support the practical application of this global normative guidance at the country level.Introduction:Community health worker (CHW) incentives and remuneration are core issues affecting the performance of CHWs and health programs. There is limited documentation on the implementation details of CHW financial compensation schemes used in sub-Saharan African countries, including their mechanisms of delivery and effectiveness. We aimed to document CHW financial compensation schemes and understand CHW, government, and other stakeholder perceptions of their effectiveness.Methods:A total of 68 semistructured interviews were conducted with a range of purposefully selected key informants in 7 countries: Benin, Burkina Faso, Ghana, Malawi, Mali, Niger, and Zambia. Thematic analysis of coded interview data was conducted, and relevant country documentation was reviewed, including any documents referenced by key informants, to provide contextual background for qualitative interpretation.Results:Key informants described compensation schemes as effective when payments are regular, distributions are consistent, and amounts are sufficient to support health worker performance and continuity of service delivery. CHW compensation schemes associated with an employed worker status and government payroll mechanisms were most often perceived as effective by stakeholders. Compensation schemes associated with a volunteer status were found to vary widely in their delivery mechanisms (e.g., cash or mobile phone distribution) and were perceived as less effective. Lessons learned in implementing CHW compensation schemes involved the need for government leadership, ministerial coordination, community engagement, partner harmonization, and realistic transitional financing plans.Conclusion:Policymakers should consider these findings in designing compensation schemes for CHWs engaged in routine, continuous health service delivery within the context of their country’s health service delivery model. Systematic documentation of the tasks and time commitment of volunteer status CHWs could support more recognition of their health system contributions and better determination of commensurate compensation as recommended by the 2018 World Health Organization Guidelines on Health Policy and System Support to Optimize Community Health Worker Programs.