BRAC Uganda is using para-skilled volunteer community health workers (CHWs) to extend the reach of the existing health system to underserved communities. The objective of this study is to evaluate, using a randomized control trial (RCT), the effectiveness and cost-effectiveness of several types of non-financial incentive packages in improving community health worker motivation and performance, and in turn, maternal and child health outcomes in Uganda. The study is being conducted on 2,800 community health promoters (CHPs) implemented by BRAC Health Program.
Researchers: Dr Kevin McKague; Dr Jenipher T Musoke
Partners: BRAC Uganda; International Development Research Centre (IDRC)
Timeline: 2015-2020
Status: Ongoing
Contact: Patrick Olobo Okello
patrick.okello@BRAC.net
Context
BRAC has trained 2,724 CHWs in Uganda, adopting a model that BRAC had developed over decades in Bangladesh, which is now applied to South Sudan, Uganda, Sierra Leone, Liberia, and Tanzania. Although CHWs are essential for implementing interventions to improve maternal and child health in low-income countries with limited health infrastructure, motivating CHW’s performance is a widespread challenge. However, any consideration for motivating CHWs must take into consideration the lack of financial incentives in many contexts. In Uganda, CHWs are required to operate as volunteers, since a salary is seen as financially constraining and unsustainable.
Research Questions
The research questions of the study are:
- How do the activities of CHWs differ by alternative modes of income support?
- Are these changes in activities influenced by the form of income support?
- What are the effects of the income support models on health outcomes of target populations and on CHWs?
Methodology
A cluster RCT was applied to test three different incentive models for 2,800 CHWs implemented by BRAC Health Program in Uganda. By randomising at the BRAC branch level, there is one arm where the current model is implemented—“business as usual.” In the second group of branches (T1), the product basket is limited only to the core health products. In the third group of branches (T2), the product basket is the same as the second group, but the CHWs receive additional income support as a “fixed honorarium.” The size of this honorarium is equivalent to the average income that the CHPs in the “business as usual” group earn from the sales of non-health products (approximately $10/month).
Findings and Recommendations
Study ongoing.
