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Abstract：
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.
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.
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.
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.
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.
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.
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.
摘要：
背景：社区卫生工作者（CHW）的激励和报酬是影响CHW和健康计划绩效的核心问题。关于撒哈拉以南非洲国家使用的CHW财政补偿计划的实施细节的文件有限，包括其交付机制和有效性。我们旨在记录CHW的经济补偿计划，并了解CHW，政府,以及其他利益相关者对其有效性的看法。
方法：共进行了68次半结构化访谈，对7个国家/地区的一系列有目的地选择的关键线人进行了访谈：贝宁，布基纳法索,加纳,马拉维,马里,尼日尔,赞比亚。对编码访谈数据进行了主题分析，并审查了相关的国家文件，包括关键线人引用的任何文件，为定性解释提供语境背景。
结果：主要信息提供者描述了补偿计划在定期付款时有效，分布是一致的，和金额足以支持卫生工作者的表现和服务提供的连续性。与雇用工人身份和政府工资机制相关的CHW补偿计划通常被利益相关者视为有效。发现与志愿者身份相关的补偿计划在其交付机制上差异很大(例如，现金或手机分销)，并被认为效果较差。实施CHW补偿计划的经验教训涉及政府领导的需要，部长级协调,社区参与,合作伙伴协调，和现实的过渡性融资计划。
结论：政策制定者在为从事日常工作的CHW设计补偿计划时应考虑这些发现，在本国卫生服务提供模式的背景下，持续提供卫生服务。关于志愿者身份CHWs的任务和时间承诺的系统文件可以支持更多地承认他们的卫生系统贡献，并根据2018年世界卫生组织《卫生政策和系统支持优化社区卫生工作者计划指南》的建议，更好地确定相应的补偿。
方法：共进行了68次半结构化访谈，对7个国家/地区的一系列有目的地选择的关键线人进行了访谈：贝宁，布基纳法索,加纳,马拉维,马里,尼日尔,赞比亚。对编码访谈数据进行了主题分析，并审查了相关的国家文件，包括关键线人引用的任何文件，为定性解释提供语境背景。
结果：主要信息提供者描述了补偿计划在定期付款时有效，分布是一致的，和金额足以支持卫生工作者的表现和服务提供的连续性。与雇用工人身份和政府工资机制相关的CHW补偿计划通常被利益相关者视为有效。发现与志愿者身份相关的补偿计划在其交付机制上差异很大(例如，现金或手机分销)，并被认为效果较差。实施CHW补偿计划的经验教训涉及政府领导的需要，部长级协调,社区参与,合作伙伴协调，和现实的过渡性融资计划。
结论：政策制定者在为从事日常工作的CHW设计补偿计划时应考虑这些发现，在本国卫生服务提供模式的背景下，持续提供卫生服务。关于志愿者身份CHWs的任务和时间承诺的系统文件可以支持更多地承认他们的卫生系统贡献，并根据2018年世界卫生组织《卫生政策和系统支持优化社区卫生工作者计划指南》的建议，更好地确定相应的补偿。
