Dataset Information

Compensation models for community health workers: Comparison of legal frameworks across five countries.

ABSTRACT:

Background

Despite the life-saving work they perform, community health workers (CHWs) have long been subject to global debate about their remuneration. There is now, however, an emerging consensus that CHWs should be paid. As the discussion evolves from whether to financially remunerate CHWs to how to do so, there is an urgent need to better understand the types of CHW payment models and their implications.

Methods

This study examines the legal framework on CHW compensation in five countries: Brazil, Ghana, Nigeria, Rwanda, and South Africa. In order to map the characteristics of each approach, a review of the regulatory framework governing CHW compensation in each country was undertaken. Law firms in each of the five countries were engaged to support the identification and interpretation of relevant legal documents. To guide the search and aid in the creation of uniform country profiles, a standardized set of questions was developed, covering: (i) legal requirements for CHW compensation, (ii) CHW compensation mechanisms, and (iii) CHW legal protections and benefits.

Results

The five countries profiled represent possible archetypes for CHW compensation: Brazil (public), Ghana (volunteer-based), Nigeria (private), Rwanda (cooperatives with performance based incentives) and South Africa (hybrid public/private). Advantages and disadvantages of each model with respect to (i) CHWs, in terms of financial protection, and (ii) the health system, in terms of ease of implementation, are outlined.

Conclusions

While a strong legal framework does not necessarily translate into high-quality implementation of compensation practices, it is the first necessary step. Certain approaches to CHW compensation - particularly public-sector or models with public sector wage floors - best institutionalize recommended CHW protections. Political will and long-term financing often remain challenges; removing ecosystem barriers - such as multilateral and bilateral restrictions on the payment of salaries - can help governments institutionalize CHW payment.

SUBMITTER: Ballard M

PROVIDER: S-EPMC7916445 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

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Publications

Compensation models for community health workers: Comparison of legal frameworks across five countries.

Ballard Madeleine M Westgate Carey C Alban Rebecca R Choudhury Nandini N Adamjee Rehan R Schwarz Ryan R Bishop Julia J McLaughlin Meg M Flood David D Finnegan Karen K Rogers Ash A Olsen Helen H Johnson Ari A Palazuelos Daniel D Schechter Jennifer J

Journal of global health 20210215

<h4>Background</h4>Despite the life-saving work they perform, community health workers (CHWs) have long been subject to global debate about their remuneration. There is now, however, an emerging consensus that CHWs should be paid. As the discussion evolves from <i>whether</i> to financially remunerate CHWs to <i>how to do so</i>, there is an urgent need to better understand the types of CHW payment models and their implications.<h4>Methods</h4>This study examines the legal framework on CHW compe ...[more]

PMID: 33692894

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Project description:BackgroundNational programs for non-communicable diseases (NCD) prevention and control in different low middle income countries have a strong community component. A community health worker (CHW) delivers NCD preventive services using informational as well as behavioural approaches. Community education and interpersonal communication on lifestyle modifications is imparted with focus on primordial prevention of NCDs and screening is conducted as part of early diagnosis and management. However, the effectiveness of health promotion and screening interventions delivered through community health workers needs to be established.ObjectiveThis review synthesised evidence on effectiveness of CHW delivered NCD primary prevention interventions in low and middle-income countries (LMICs).MethodsA systematic review of trials that utilised community health workers for primary prevention/ early detection strategy in the management of NCDs (Diabetes, cardiovascular diseases (CVD), cancers, stroke, Chronic Obstructive Pulmonary Diseases (COPD)) in LMICs was conducted. Digital databases like PubMed, EMBASE, OVID, Cochrane library, dissertation abstracts, clinical trials registry web sites of different LMIC were searched for such publications between years 2000 and 2015. We focussed on community based randomised controlled trial and cluster randomised trials without any publication language limitation. The primary outcome of review was percentage change in population with different behavioural risk factors. Additionally, mean overall changes in levels of several physical or biochemical parameters were studied as secondary outcomes. Subgroup analyses was performed by the age and sex of participants, and sensitivity analyses was conducted to assess the robustness of the findings.ResultsSixteen trials meeting the inclusion criteria were included in the review. Duration, study populations and content of interventions varied across trials. The duration of the studies ranged from mean follow up of 4 months for some risk factors to 19 months, and primary responsibilities of health workers included health promotion, treatment adherence and follow ups. Only a single trial reported all-cause mortality. The pooled effect computed indicated an increase in tobacco cessation (RR: 2.0, 95%CI: 1.11, 3.58, moderate-quality evidence) and a decrease in systolic blood pressure ((MD: -4.80, 95% CI: -8.12, -1.49, I2 = 93%, very low-quality evidence), diastolic blood pressure ((MD: -2.88, 95% CI: -5.65, -0.10, I2 = 96%, very low-quality evidence)) and blood sugar levels (glycated haemoglobin MD: -0.83%, 95%CI: -1.25,-0.41). None of the included trials reported on adverse events.ConclusionsEvidence on the implementation of primary prevention strategies using community health workers is still developing. Existing evidence suggests that, compared with standard care, using CHWs in health programmes have the potential to be effective in LMICs, particularly for tobacco cessation, blood pressure and diabetes control.

Dataset Information

Compensation models for community health workers: Comparison of legal frameworks across five countries.

Background

Methods

Results

Conclusions

Publications

Compensation models for community health workers: Comparison of legal frameworks across five countries.

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