SynthesisBulletin of the World Health Organization2021
Performance-based incentives and community health workers' outputs, a systematic review.
Synthesis in Bulletin of the World Health Organization, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
19 citing papers in PubMed.
- "The satisfaction we get by doing this, you do not get it with any money": Experiences, and motivations of, and strategies used by community volunteers delivering social or health interventions in India.PLOS global public health · 2026Article
- Improving Community Health Program: Perspective of Community Health Workers in the Eastern Cape, South Africa.Risk management and healthcare policy · 2025Article
- Effects of financial compensation structures on community health worker performance, motivation, and retention: evidence from a multi-arm quasi-experiment in Uganda.Frontiers in health services · 2025Article
- Traditional Midwifery Contribution to Safe Birth in Cultural Safety: Narrative Evaluation of an Intervention in Guerrero, Mexico.Community health equity research & policy · 2024Article
- Vitamin A supplementation coverage and associated factors for children aged 6 to 59 months in integrated and campaign-based delivery systems in four sub-Saharan African countries.BMC public health · 2024Article
- Barriers and strategies for primary health care workforce development: synthesis of evidence.BMC primary care · 2024Review
- Engaging Community Health Workers (CHWs) in Africa: Lessons from the Canadian Red Cross supported programs.PLOS global public health · 2024Article
- A Feasibility Study Describing the Successes and Challenges of Implementing a Virtual Community Health Worker Training Among High School Students Participating in a Summer STEM Enrichment Program.Journal of STEM outreach · 2024Article
- Article
- Recruitment and selection of community health workers in Iran; a thematic analysis.BMC public health · 2023Article
- Community Health Workers as Vaccinators: A Rapid Review of the Global Landscape, 2000-2021.Global health, science and practice · 2023Review
- How different incentives influence reported motivation and perceptions of performance in Ghanaian community-based health planning and services zones.BMC research notes · 2023Article
- Community health workers and Covid-19: Cross-country evidence on their roles, experiences, challenges and adaptive strategies.PLOS global public health · 2023Article
- Using Financial Incentives and Market Mechanisms to Improve Hospitals' Performance; A Double-edged Sword.International journal of health policy and management · 2023Article
- It is not all about salary: a discrete-choice experiment to determine community health workers' motivation for work in Nigeria.BMJ global health · 2022Article
- Improving Community Health Worker Compensation: A Case Study From India Using Quantitative Projection Modeling and Incentive Design Principles.Global health, science and practice · 2022Article
- The Lancet Global Health Commission on financing primary health care: putting people at the centre.The Lancet. Global health · 2022Review
- Maternal, Sexual and Reproductive Health in Marginalised Areas: Renewing Community Involvement Strategies beyond the Worst of the COVID-19 Pandemic.International journal of environmental research and public health · 2022Article
- Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo review the evidence on the impact on measurable outcomes of performance-based incentives for community health workers (CHWs) in low- and middle-income countries.
methodsWe conducted a systematic review of intervention studies published before November 2020 that evaluated the impact of financial and non-financial performance-based incentives for CHWs. Outcomes included patient health indicators; quality, utilization or delivery of health-care services; and CHW motivation or satisfaction. We assessed risk of bias for all included studies using the Cochrane tool. We based our narrative synthesis on a framework for measuring the performance of CHW programmes, comprising inputs, processes, performance outputs and health outcomes.
findingsTwo reviewers screened 2811 records; we included 12 studies, 11 of which were randomized controlled trials and one a non-randomized trial. We found that non-financial, publicly displayed recognition of CHWs' efforts was effective in improved service delivery outcomes. While large financial incentives were more effective than small ones in bringing about improved performance, they often resulted in the reallocation of effort away from other, non-incentivized tasks. We found no studies that tested a combined package of financial and non-financial incentives. The rationale for the design of performance-based incentives or explanation of how incentives interacted with contextual factors were rarely reported.
conclusionFinancial performance-based incentives alone can improve CHW service delivery outcomes, but at the risk of unincentivized tasks being neglected. As calls to professionalize CHW programmes gain momentum, research that explores the interactions among different forms of incentives, context and sustainability is needed.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.