CITATION: Which intervention design factors influence performance of community health workers in low- and middle-income countries? A systematic review
Maryse C Kok, Marjolein Dieleman, Miriam Taegtmeyer, Jacqueline EW Broerse, Sumit S Kane, Hermen Ormel, Mandy M Tijm1 and Korrie AM de Koning
Health Policy and Planning 2015;30:12071227 doi:10.1093//heapol/czu126
A mix of financial and non-financial incentives, predictable for the CHWs, was found to be an effective strategy to enhance performance, especially of those CHWs with multiple tasks. Performance-based financial incentives sometimes resulted in neglect of unpaid tasks. Intervention designs which involved frequent supervision and continuous training led to better CHW performance in certain settings. Supervision and training were often mentioned as facilitating factors, but few studies tested which approach worked best or how these were best implemented. Embedment of CHWs in community and health systems was found to diminish workload and increase CHW credibility. Clearly defined CHW roles and introduction of clear processes for communication among different levels of the health system could strengthen CHW performance.
When designing community-based health programmes, factors that increased CHW performance in comparable settings should be taken into account. Additional intervention research to develop a better evidence base for the most effective training and supervision mechanisms and qualitative research to inform policymakers in development of CHW interventions are needed.