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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







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


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


Decreased IMR under-5 mortality and morbidity


Required to work for 4 years in government service

93.5–99% over a 1- to 6-year period



85% over 5 years


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


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