Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
Population Council, Washington, District of Columbia, USA.
BMJ Open. 2019 Dec 11;9(12):e033601. doi: 10.1136/bmjopen-2019-033601.
There is a renewed global interest in improving community health worker (CHW) programmes. For CHW programmes to be effective, key intervention design factors which contribute to the performance of CHWs need to be identified. The recent WHO guidelines recommends the combination of financial and non-financial incentives to improve CHW performance. However, evidence gaps remain as to what package of incentives will improve their performance in different country contexts. This study aims to evaluate CHW incentive preferences to improve performance and retention which will strengthen CHW programmes and help governments leverage limited resources appropriately.
A discrete choice experiment (DCE) will be conducted with CHWs in Bangladesh, Haiti, Kenya and Uganda with different levels of maturity of CHWs programmes. This will be carried out in two phases. Phase 1 will involve preliminary qualitative research including focus group discussions (FGDs) and key informant interviews to develop the DCE design which will include attributes relevant to the CHW country settings. Phase 2 will involve a DCE survey with CHWs, presenting them with a series of job choices with varying attribute levels. An orthogonal design will be used to generate the choice sets for the surveys. The surveys will be administered in locally-appropriate languages to at least 150 CHWs from each of the cadres in each country. Conditional and mixed multinomial logit (MMNL) models will be used for the estimation of stated preferences.
This study has been reviewed and approved by the Population Council's Institutional Review Board in New York, and appropriate ethics review boards in Kenya, Uganda, Bangladesh and Haiti. The results of the study will be disseminated through in-country dissemination workshops, meetings with country-level stakeholders and policy working groups, print media, online blogs and peer-reviewed journals.
提高社区卫生工作者（CHW）计划在全球范围内重新受到关注。为了使 CHW 计划有效，需要确定有助于 CHW 表现的关键干预设计因素。最近的世卫组织指南建议将财务和非财务激励措施相结合，以提高 CHW 的绩效。然而，在不同的国家背景下，哪种激励方案将提高他们的绩效，仍存在证据差距。本研究旨在评估 CHW 的激励偏好，以提高绩效和保留率，从而加强 CHW 计划，并帮助政府合理利用有限的资源。
将在孟加拉国、海地、肯尼亚和乌干达开展一项离散选择实验（DCE），这些国家的 CHW 计划有不同的成熟度。这将分两个阶段进行。第一阶段将包括初步的定性研究，包括焦点小组讨论（FGD）和关键知情人访谈，以制定 DCE 设计，其中将包括与 CHW 国家背景相关的属性。第二阶段将涉及 CHW 的 DCE 调查，向他们展示一系列具有不同属性水平的工作选择。将使用正交设计为调查生成选择集。将以当地适当的语言向每个国家的每个职系至少 150 名 CHW 进行调查。将使用条件和混合多项逻辑回归（MMNL）模型来估计陈述的偏好。
这项研究已经在纽约的人口理事会机构审查委员会以及肯尼亚、乌干达、孟加拉国和海地的适当伦理审查委员会进行了审查和批准。研究结果将通过在国内的传播研讨会、与国家一级利益攸关方和政策工作组的会议、印刷媒体、在线博客和同行评议期刊进行传播。
