Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Dec 11;9(12):e033601.
doi: 10.1136/bmjopen-2019-033601.

Understanding incentive preferences of community health workers using discrete choice experiments: a multicountry protocol for Kenya, Uganda, Bangladesh and Haiti

Smisha Agarwal  1 , Udochisom Anaba  2 , Timothy Abuya  3 , Richard Kintu  4 , Alain Casseus  5 , Sharif Hossain  6 , Melvin Obadha  7 , Charlotte E Warren  2
Affiliations

Understanding incentive preferences of community health workers using discrete choice experiments: a multicountry protocol for Kenya, Uganda, Bangladesh and Haiti

Smisha Agarwal et al. BMJ Open. .

Abstract

Introduction: There is a renewed global interest in improving community health worker (CHW) programmes. For CHW programmes to be effective, key intervention design factors which contribute to the performance of CHWs need to be identified. The recent WHO guidelines recommends the combination of financial and non-financial incentives to improve CHW performance. However, evidence gaps remain as to what package of incentives will improve their performance in different country contexts. This study aims to evaluate CHW incentive preferences to improve performance and retention which will strengthen CHW programmes and help governments leverage limited resources appropriately.

Methods and analysis: A discrete choice experiment (DCE) will be conducted with CHWs in Bangladesh, Haiti, Kenya and Uganda with different levels of maturity of CHWs programmes. This will be carried out in two phases. Phase 1 will involve preliminary qualitative research including focus group discussions (FGDs) and key informant interviews to develop the DCE design which will include attributes relevant to the CHW country settings. Phase 2 will involve a DCE survey with CHWs, presenting them with a series of job choices with varying attribute levels. An orthogonal design will be used to generate the choice sets for the surveys. The surveys will be administered in locally-appropriate languages to at least 150 CHWs from each of the cadres in each country. Conditional and mixed multinomial logit (MMNL) models will be used for the estimation of stated preferences.

Ethics and dissemination: This study has been reviewed and approved by the Population Council's Institutional Review Board in New York, and appropriate ethics review boards in Kenya, Uganda, Bangladesh and Haiti. The results of the study will be disseminated through in-country dissemination workshops, meetings with country-level stakeholders and policy working groups, print media, online blogs and peer-reviewed journals.

Keywords: community health systems; community health workers; discrete choice experiment; incentives.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

References

    1. Darzi A, Evans T. The global shortage of health workers—an opportunity to transform care. The Lancet 2016;388:2576–7. 10.1016/S0140-6736(16)32235-8 - DOI - PubMed
    1. Perry HB, Zulliger R, Rogers MM. Community health workers in low-, middle-, and high-income countries: an overview of their history, recent evolution, and current effectiveness. Annu Rev Public Health 2014;35:399–421. 10.1146/annurev-publhealth-032013-182354 - DOI - PubMed
    1. O’Donovan J, O’Donovan C, Kuhn I, et al. Ongoing training of community health workers in low-income and middle-income countries: a systematic scoping review of the literature. BMJ Open 2018;8. - PMC - PubMed
    1. World Health Organisation Declaration of Alma-Ata. Alma-Ata, USSR: International Conference on Primary Health Care, 1978: 6–12.
    1. Christopher JB, Le May A, Lewin S, et al. Thirty years after Alma-Ata: a systematic review of the impact of community health workers delivering curative interventions against malaria, pneumonia and diarrhoea on child mortality and morbidity in sub-Saharan Africa. Hum Resour Health 2011;9:27 10.1186/1478-4491-9-27 - DOI - PMC - PubMed

Publication types

MeSH terms

LinkOut - more resources