ArticleBMC health services research2021
What is the impact of removing performance-based financial incentives on community health worker motivation? A qualitative study from an infant and young child feeding program in Bangladesh.
Article in BMC health services research, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
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Who cites it
14 citing papers in PubMed, 22 citations in OpenAlex.
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- Incentives on the motivation and job performance; insights from community health workers in Iran.BMC health services research · 2025Article
- Evidence-Based Lessons From Two Decades of Implementation Research on Complementary Feeding Programmes.Maternal & child nutrition · 2025Review
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- Exploring existing malaria services and the feasibility of implementing community engagement approaches amongst conflict-affected communities in Cameroon: a qualitative study.Malaria journal · 2024Article
- Expanded roles of community health workers to sustain malaria services in the Asia-Pacific: A landscaping survey.PLOS global public health · 2024Article
- Estimated impact from the withdrawal of primary care financial incentives on selected indicators of quality of care in Scotland: controlled interrupted time series analysis.BMJ (Clinical research ed.) · 2023Article
- How different incentives influence reported motivation and perceptions of performance in Ghanaian community-based health planning and services zones.BMC research notes · 2023Article
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- Impact and Sustainability of Foreign Medical Aid: A Qualitative Study with Honduran Healthcare Providers.Annals of global health · 2023Article
- Does mHealth influence community health worker performance in vulnerable populations? A mixed methods study in a multinational refugee settlement in Uganda.PLOS global public health · 2023Article
- Implementation barriers and remedial strategies for community-based health insurance in Bangladesh: insights from national stakeholders.BMC health services research · 2022Article
- Assessing sustainment of health worker outcomes beyond program end: Evaluation results from an infant and young child feeding intervention in Bangladesh.Frontiers in health services · 2022Article
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Authors and funding
12 authors at 7 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundCommunity health worker (CHW) motivation is an important factor related to health service quality and CHW program sustainability in low- and middle-income countries. Financial and non-financial motivators may influence CHW behavior through two dimensions of motivation: desire to perform and effort expended. The aim of this study was to explore how the removal of performance-based financial incentives impacted CHW motivation after formal funding ceased for Alive and Thrive (A&T), an infant and young child feeding (IYCF) program in Bangladesh.
methodsThis qualitative study included seven focus groups (n = 43 respondents) with paid supervisors of volunteer CHWs tasked with delivering interpersonal IYCF counseling services. Data were transcribed, translated into English, and then analyzed using both a priori themes and a grounded theory approach.
resultsResults suggest the removal of financial incentives was perceived to have negatively impacted CHWs' desire to perform in three primary ways: 1) a decreased desire to work without financial compensation, 2) changes in pre- and post-intervention motivation, and 3) household income challenges due to dependence on incentives. Removal of financial incentives was perceived to have negatively impacted CHWs' level of effort expended in four primary ways: 1) a reduction in CHW visits, 2) a reduction in quality of care, 3) CHW attrition, and 4) substitution of other income-generating activities.
conclusionsThis study provides new evidence regarding how removing performance-based financial incentives from a CHW program can negatively impact CHW motivation. The findings suggest that program decision makers should consider how to construct community health work programs such that CHWs may continue to receive performance-based compensation after the original funding ceases.
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