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Table 7 Rewarding and sanctioning CHWs

From: How should community health workers in fragile contexts be supported: qualitative evidence from Sierra Leone, Liberia and Democratic Republic of Congo

  Strategies Challenges
Rewarding CHWs
“We think that the high performing CHWs should be recognised and awarded. This will make a big difference to how they feel appreciated”.
(National decision maker, male, Liberia).
Selecting active CHWs for programme activities where they will be given a financial incentive Not enough rewards and recognition
Sharing food or small financial incentives during meetings Create annual awards, certificates and radio announcement
Providing verbal praise Community recognition needs to be stronger in some areas: community members need to support CHWs with their farm work so that they can focus on their health work.
Assuring CHWs that they have the community’s and God’s recognition  
Sanctioning CHWs
“You know, it is not easy in our context to manage someone who works voluntarily, and does not benefit from financial incentives. It is just too difficult to objectively manage them”. (Facility manager, female, DRC).
More closely monitoring the CHWs and providing encouragement Difficult to dismiss poorly performing CHWs
Providing additional training and support Time and resource consuming to replace CHWs
Talking with the community to try to resolve performance problems  
Occasionally, threatening not to submit the CHW report to the facility which would prevent them receiving their allowance.