Table 2 Summary of CHW programmes in the case studies
|  | Iran Behvarzs | Ethiopia Health Extension Workers – blended programme of full time and part time | India Accredited Social Health Activists (ASHAs) | Bangladesh Community Health Volunteers (CHVs) | Nepal Female Community Health Volunteers (FCHVs) |
|---|---|---|---|---|---|
Behavioural Economics Model | Monetary market: paid for full-time work | Monetary market: paid for full-time work | Mixed market: incentives | Mixed market: selling of health commodities | Social market: volunteers |
Working hours | Full time | Full time | Part time | Part time 15–20 h | Part-time 5–10 h per week |
Current number | 31 000 | 38 000 | 820 000 | 80 000 | 48 000 |
Minimum education level | Completed high school | Grade 10 | Grade 8 | Some years of school | Literate if possible |
Ratio | 1:1500 | 1:2500 | 1:1000 | 1:1500 | 1:400 |
Training and supervision | 2 years full time, refresher courses and monthly meetings | 1 year full time | 23 days then attend weekly meeting | Initial 21 days then supervised 2–3 times a month | Initial 15 days then refresher once a month |
Impact | Reduced IMR, MMR, increased life expectancy | Decreased MMR, IMR, increased family planning, clean water, HIV tests | Increased facility-based deliveries, decreased MMR and neonatal mortality | NA | Decreased IMR under-5 mortality and morbidity |
Retention | Required to work for 4 years in government service | 93.5–99% over a 1- to 6-year period | NA | 84–89% | 85% over 5 years |
Advantages | High-retention rates, high-quality service in rural areas | High coverage, allows for extension of health services and community engagement | Increased coverage for specific health interventions | Marginalized women have a chance to earn small incomes and to engage in health | High levels of community good will and support |
Disadvantages | High cost, long training period before starting to work | High cost, long training period before starting to work | Focus on incentivized health interventions | Focus on selling health commodities could distract from health issues | Other commitments may create less time for the field work |