TY - JOUR
T1 - A performance-based incentives system for village health workers in Kisoro, Uganda
AU - Zheng, Crystal
AU - Musominali, Sam
AU - Chaw, Gloria Fung
AU - Paccione, Gerald
N1 - Funding Information:
Kisoro district is in southwest Uganda, 200 kilometers away from Mbarara, the nearest major city. Its population of 287,000 includes 94% living in rural areas and 89% working as subsistence farmers. Only 17% of adults have completed primary school [7, 8]. In January 2007, Kisoro District Hospital (KDH) initiated a VHW program with a mission to deliver broad primary care. The program is funded by Doctors for Global Health (a US-based NGO) and by partnerships with US medical schools that contribute funds to support global health opportunities for medical students. In this way we established a collaborative model of medical education that serves the sponsoring community and keeps the VHW program financially sustainable. Whereas many VHW programs are “vertical,” delivering one type of intervention, ours is a “horizontal” program in which VHWs deliver a comprehensive set of preventive, educational, and curative health actions. The program currently includes 53 VHWs and covers a population of roughly 50,000 across 50 villages.
Publisher Copyright:
© 2019 The Author(s).
PY - 2019
Y1 - 2019
N2 - Background: Village health worker (VHW) programs in Uganda have achieved limited success, due in part to a reliance on volunteerism and a lack of standardized incentive mechanisms. However, how to best incentivize VHWs remains unclear. Doctors for Global Health developed a performance-based incentives (PBI) system to pay its VHWs in Kisoro, Uganda, based on performance of tasks or achievement of targets. Objectives: 1. To describe the development of a PBI system used to compensate VHWs. 2. To report cost and health services delivery outcomes under a PBI system. 3. To provide qualitative analysis on the successes and challenges of PBI. Methods: Internal organization records from May 2016 to April 2017 were retrospectively reviewed. The results of descriptive and analytic statistics were reported. Qualitative analysis was performed by the authors. Findings: In one year, 42 VHWs performed 23,703 remunerable health actions, such as providing care of minor ailments and chronic disease. VHWs earned on average $237. The total cost to maintain the program was $29,844, or $0.72 per villager. There was 0% VHW attrition. Strengths of PBI included flexibility, accountability, higher VHW earnings, and improved monitoring and evaluation. Conclusions: PBI is a feasible and sustainable model of compensating VHWs. At a time where VHW programs are sorely needed to address limitations in healthcare resources, yet are facing challenges with workforce compensation, PBI may serve as a model for others in Uganda and around the world.
AB - Background: Village health worker (VHW) programs in Uganda have achieved limited success, due in part to a reliance on volunteerism and a lack of standardized incentive mechanisms. However, how to best incentivize VHWs remains unclear. Doctors for Global Health developed a performance-based incentives (PBI) system to pay its VHWs in Kisoro, Uganda, based on performance of tasks or achievement of targets. Objectives: 1. To describe the development of a PBI system used to compensate VHWs. 2. To report cost and health services delivery outcomes under a PBI system. 3. To provide qualitative analysis on the successes and challenges of PBI. Methods: Internal organization records from May 2016 to April 2017 were retrospectively reviewed. The results of descriptive and analytic statistics were reported. Qualitative analysis was performed by the authors. Findings: In one year, 42 VHWs performed 23,703 remunerable health actions, such as providing care of minor ailments and chronic disease. VHWs earned on average $237. The total cost to maintain the program was $29,844, or $0.72 per villager. There was 0% VHW attrition. Strengths of PBI included flexibility, accountability, higher VHW earnings, and improved monitoring and evaluation. Conclusions: PBI is a feasible and sustainable model of compensating VHWs. At a time where VHW programs are sorely needed to address limitations in healthcare resources, yet are facing challenges with workforce compensation, PBI may serve as a model for others in Uganda and around the world.
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U2 - 10.5334/aogh.2400
DO - 10.5334/aogh.2400
M3 - Article
C2 - 30924618
AN - SCOPUS:85064111822
VL - 85
JO - Annals of Global Health
JF - Annals of Global Health
SN - 0027-2507
IS - 1
M1 - 46
ER -