Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA.
School of Public Health, University of Alberta, Edmonton, AB, Canada.
Health Res Policy Syst. 2021 Oct 12;19(Suppl 3):106. doi: 10.1186/s12961-021-00750-w.
This is the eighth in our series of 11 papers on "CHWs at the Dawn of a New Era". Community health worker (CHW) incentives and remuneration are core issues that affect the performance of individual CHWs and the performance of the overall CHW programme. A better understanding of what motivates CHWs and a stronger awareness of the social justice dimensions of remuneration are essential in order to build stronger CHW programmes and to support the professionalization of the CHW workforce.
We provide examples of incentives that have been provided to CHWs and identify factors that motivate and demotivate CHWs. We developed our findings in this paper by synthesizing the findings of a recent review of CHW motivation and incentives in a wide variety of CHW programmes with detailed case study data about CHW compensation and incentives in 29 national CHW programmes.
Incentives can be direct or indirect, and they can be complementary/demand-side incentives. Direct incentives can be financial or nonfinancial. Indirect incentives can be available through the health system or from the community, as can complementary, demand-side incentives. Motivation is sustained when CHWs feel they are a valued member of the health system and have a clear role and set of responsibilities within it. A sense of the "do-ability" of the CHW role is critical in maintaining CHW motivation. CHWs are best motivated by work that provides opportunities for personal growth and professional development, irrespective of the direct remuneration and technical skills obtained. Working and social relationships among CHWs themselves and between CHWs and other healthcare professionals and community members strongly shape CHW motivation.
Our findings support the recent guidelines for CHWs released by WHO in 2018 that call for CHWs to receive a financial package that corresponds to their job demands, complexity, number of hours worked, training, and the roles they undertake. The guidelines also call for written agreements that specify the CHW's role and responsibilities, working conditions, remuneration, and workers' rights.
这是我们关于“新时代黎明中的社区卫生工作者”系列文章的第 8 篇。社区卫生工作者（CHW）的激励和薪酬是影响个体 CHW 表现和整个 CHW 项目表现的核心问题。为了建立更强大的 CHW 项目并支持 CHW 劳动力的专业化，更好地了解激励 CHW 的因素以及薪酬的社会正义维度的意识至关重要。
我们提供了已经提供给 CHW 的激励措施的示例，并确定了激励和削弱 CHW 的因素。我们通过综合最近对各种 CHW 项目中 CHW 激励措施的审查结果，以及 29 个国家 CHW 项目中 CHW 薪酬和激励措施的详细案例研究数据，得出了本文的研究结果。
激励措施可以是直接的或间接的，也可以是互补的/需求方激励措施。直接激励措施可以是财务的或非财务的。间接激励措施可以通过卫生系统或社区提供，也可以通过互补的、需求方的激励措施提供。当 CHW 感到自己是卫生系统中有价值的一员，并且在其中有明确的角色和职责时，激励就会持续下去。CHW 角色的“可操作性”感对于维持 CHW 的激励至关重要。CHW 最受激励的是提供个人成长和专业发展机会的工作，而不论获得的直接报酬和技术技能如何。CHW 之间的工作和社会关系以及 CHW 与其他医疗保健专业人员和社区成员之间的关系，强烈影响着 CHW 的激励。
我们的研究结果支持世界卫生组织（WHO）在 2018 年发布的 CHW 最新指南，该指南呼吁为 CHW 提供与其工作需求、复杂性、工作时间、培训和承担的角色相对应的一揽子财务报酬。该指南还呼吁制定书面协议，明确 CHW 的角色和职责、工作条件、薪酬和工人权利。
