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Table 2 Summary of CHW programmes in the case studies

From: The effect of payment and incentives on motivation and focus of community health workers: five case studies from low- and middle-income countries

  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