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Compensation models for community health workers: Comparison of legal frameworks across five countries
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...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
International Society of Global Health
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7916445/ https://www.ncbi.nlm.nih.gov/pubmed/33692894 http://dx.doi.org/10.7189/jogh.11.04010 |
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author | Ballard, Madeleine Westgate, Carey Alban, Rebecca Choudhury, Nandini Adamjee, Rehan Schwarz, Ryan Bishop, Julia McLaughlin, Meg Flood, David Finnegan, Karen Rogers, Ash Olsen, Helen Johnson, Ari Palazuelos, Daniel Schechter, Jennifer |
author_facet | Ballard, Madeleine Westgate, Carey Alban, Rebecca Choudhury, Nandini Adamjee, Rehan Schwarz, Ryan Bishop, Julia McLaughlin, Meg Flood, David Finnegan, Karen Rogers, Ash Olsen, Helen Johnson, Ari Palazuelos, Daniel Schechter, Jennifer |
author_sort | Ballard, Madeleine |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-7916445 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | International Society of Global Health |
record_format | MEDLINE/PubMed |
spelling | pubmed-79164452021-03-09 Compensation models for community health workers: Comparison of legal frameworks across five countries Ballard, Madeleine Westgate, Carey Alban, Rebecca Choudhury, Nandini Adamjee, Rehan Schwarz, Ryan Bishop, Julia McLaughlin, Meg Flood, David Finnegan, Karen Rogers, Ash Olsen, Helen Johnson, Ari Palazuelos, Daniel Schechter, Jennifer J Glob Health Articles 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. International Society of Global Health 2021-02-15 /pmc/articles/PMC7916445/ /pubmed/33692894 http://dx.doi.org/10.7189/jogh.11.04010 Text en Copyright © 2021 by the Journal of Global Health. All rights reserved. http://creativecommons.org/licenses/by/4.0/ This work is licensed under a Creative Commons Attribution 4.0 International License. |
spellingShingle | Articles Ballard, Madeleine Westgate, Carey Alban, Rebecca Choudhury, Nandini Adamjee, Rehan Schwarz, Ryan Bishop, Julia McLaughlin, Meg Flood, David Finnegan, Karen Rogers, Ash Olsen, Helen Johnson, Ari Palazuelos, Daniel Schechter, Jennifer Compensation models for community health workers: Comparison of legal frameworks across five countries |
title | Compensation models for community health workers: Comparison of legal frameworks across five countries |
title_full | Compensation models for community health workers: Comparison of legal frameworks across five countries |
title_fullStr | Compensation models for community health workers: Comparison of legal frameworks across five countries |
title_full_unstemmed | Compensation models for community health workers: Comparison of legal frameworks across five countries |
title_short | Compensation models for community health workers: Comparison of legal frameworks across five countries |
title_sort | compensation models for community health workers: comparison of legal frameworks across five countries |
topic | Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7916445/ https://www.ncbi.nlm.nih.gov/pubmed/33692894 http://dx.doi.org/10.7189/jogh.11.04010 |
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