A process evaluation of performance-based incentives for village health workers in Kisoro district, Uganda

James S. Miller, Sam Musominali, Michael Baganizi, Gerald A. Paccione, Jr.

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: Designing effective incentive systems for village health workers (VHWs) represents a longstanding policy issue with substantial impact on the success and sustainability of VHW programs. Using performance-based incentives (PBI) for VHWs is an approach that has been proposed and implemented in some programs, but has not received adequate review and evaluation in the peer-reviewed literature. We conducted a process evaluation examining the use of PBI for VHWs in Kisoro, Uganda. In this system, VHWs are paid based on 20 indicators, divided among routine follow-up visits, health education activities, new patient identifications, sanitation coverage, and uptake of priority health services.Methods: Surveys of VHWs (n = 30) and program supervisors (n = 7) were conducted to assess acceptability and feasibility. Interviews were conducted with all 8 program supervisors and with 6 purposively selected VHWs to gain a deeper understanding of their views on the PBI system. Program budget records were used to assess the costs of the program. Detailed payment records were used to assess the fairness of the PBI system with respect to VHWs' gender, education level, and village location.Results: In surveys and interviews, supervisors expressed high satisfaction with the PBI system, though some supervisors expressed concerns about possible negative effects from the variation in payments between VHWs and the uncertainty of reward for effort. VHWs perceived the system as generally fair, and preferred it to the previous payment system, but expressed a desire to be paid more. The annual program cost was $516 per VHW, with each VHW covering an average of 115 households. VHWs covering more households tended to earn more. There was some evidence that female gender was associated with higher earnings. Education level and proximity to the district hospital did not appear to be associated with earnings under the PBI system.Conclusions: In a one-year pilot of PBI within a small VHW program, both VHWs and supervisors found the PBI system acceptable and motivating. VHWs with relatively limited formal education were able to master the PBI system. Further research is needed to determine the long-term effects and scalability of PBI, as well as the effects across varied contexts.

Original languageEnglish (US)
Article number19
JournalHuman Resources for Health
Volume12
Issue number1
DOIs
StatePublished - Apr 8 2014

Fingerprint

Uganda
Motivation
village
incentive
district
worker
incentive system
health
evaluation
performance
Education
program budget
Interviews
Costs and Cost Analysis
Sanitation
education
District Hospitals
Budgets
gender
Reward

Keywords

  • Developing countries
  • Incentives
  • Low-income countries
  • Primary health care
  • Uganda

ASJC Scopus subject areas

  • Public Administration
  • Public Health, Environmental and Occupational Health

Cite this

A process evaluation of performance-based incentives for village health workers in Kisoro district, Uganda. / Miller, James S.; Musominali, Sam; Baganizi, Michael; Paccione, Jr., Gerald A.

In: Human Resources for Health, Vol. 12, No. 1, 19, 08.04.2014.

Research output: Contribution to journalArticle

@article{a799a0fd67b94cd99144cb6b762fcfbb,
title = "A process evaluation of performance-based incentives for village health workers in Kisoro district, Uganda",
abstract = "Background: Designing effective incentive systems for village health workers (VHWs) represents a longstanding policy issue with substantial impact on the success and sustainability of VHW programs. Using performance-based incentives (PBI) for VHWs is an approach that has been proposed and implemented in some programs, but has not received adequate review and evaluation in the peer-reviewed literature. We conducted a process evaluation examining the use of PBI for VHWs in Kisoro, Uganda. In this system, VHWs are paid based on 20 indicators, divided among routine follow-up visits, health education activities, new patient identifications, sanitation coverage, and uptake of priority health services.Methods: Surveys of VHWs (n = 30) and program supervisors (n = 7) were conducted to assess acceptability and feasibility. Interviews were conducted with all 8 program supervisors and with 6 purposively selected VHWs to gain a deeper understanding of their views on the PBI system. Program budget records were used to assess the costs of the program. Detailed payment records were used to assess the fairness of the PBI system with respect to VHWs' gender, education level, and village location.Results: In surveys and interviews, supervisors expressed high satisfaction with the PBI system, though some supervisors expressed concerns about possible negative effects from the variation in payments between VHWs and the uncertainty of reward for effort. VHWs perceived the system as generally fair, and preferred it to the previous payment system, but expressed a desire to be paid more. The annual program cost was $516 per VHW, with each VHW covering an average of 115 households. VHWs covering more households tended to earn more. There was some evidence that female gender was associated with higher earnings. Education level and proximity to the district hospital did not appear to be associated with earnings under the PBI system.Conclusions: In a one-year pilot of PBI within a small VHW program, both VHWs and supervisors found the PBI system acceptable and motivating. VHWs with relatively limited formal education were able to master the PBI system. Further research is needed to determine the long-term effects and scalability of PBI, as well as the effects across varied contexts.",
keywords = "Developing countries, Incentives, Low-income countries, Primary health care, Uganda",
author = "Miller, {James S.} and Sam Musominali and Michael Baganizi and {Paccione, Jr.}, {Gerald A.}",
year = "2014",
month = "4",
day = "8",
doi = "10.1186/1478-4491-12-19",
language = "English (US)",
volume = "12",
journal = "Human Resources for Health",
issn = "1478-4491",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - A process evaluation of performance-based incentives for village health workers in Kisoro district, Uganda

AU - Miller, James S.

AU - Musominali, Sam

AU - Baganizi, Michael

AU - Paccione, Jr., Gerald A.

PY - 2014/4/8

Y1 - 2014/4/8

N2 - Background: Designing effective incentive systems for village health workers (VHWs) represents a longstanding policy issue with substantial impact on the success and sustainability of VHW programs. Using performance-based incentives (PBI) for VHWs is an approach that has been proposed and implemented in some programs, but has not received adequate review and evaluation in the peer-reviewed literature. We conducted a process evaluation examining the use of PBI for VHWs in Kisoro, Uganda. In this system, VHWs are paid based on 20 indicators, divided among routine follow-up visits, health education activities, new patient identifications, sanitation coverage, and uptake of priority health services.Methods: Surveys of VHWs (n = 30) and program supervisors (n = 7) were conducted to assess acceptability and feasibility. Interviews were conducted with all 8 program supervisors and with 6 purposively selected VHWs to gain a deeper understanding of their views on the PBI system. Program budget records were used to assess the costs of the program. Detailed payment records were used to assess the fairness of the PBI system with respect to VHWs' gender, education level, and village location.Results: In surveys and interviews, supervisors expressed high satisfaction with the PBI system, though some supervisors expressed concerns about possible negative effects from the variation in payments between VHWs and the uncertainty of reward for effort. VHWs perceived the system as generally fair, and preferred it to the previous payment system, but expressed a desire to be paid more. The annual program cost was $516 per VHW, with each VHW covering an average of 115 households. VHWs covering more households tended to earn more. There was some evidence that female gender was associated with higher earnings. Education level and proximity to the district hospital did not appear to be associated with earnings under the PBI system.Conclusions: In a one-year pilot of PBI within a small VHW program, both VHWs and supervisors found the PBI system acceptable and motivating. VHWs with relatively limited formal education were able to master the PBI system. Further research is needed to determine the long-term effects and scalability of PBI, as well as the effects across varied contexts.

AB - Background: Designing effective incentive systems for village health workers (VHWs) represents a longstanding policy issue with substantial impact on the success and sustainability of VHW programs. Using performance-based incentives (PBI) for VHWs is an approach that has been proposed and implemented in some programs, but has not received adequate review and evaluation in the peer-reviewed literature. We conducted a process evaluation examining the use of PBI for VHWs in Kisoro, Uganda. In this system, VHWs are paid based on 20 indicators, divided among routine follow-up visits, health education activities, new patient identifications, sanitation coverage, and uptake of priority health services.Methods: Surveys of VHWs (n = 30) and program supervisors (n = 7) were conducted to assess acceptability and feasibility. Interviews were conducted with all 8 program supervisors and with 6 purposively selected VHWs to gain a deeper understanding of their views on the PBI system. Program budget records were used to assess the costs of the program. Detailed payment records were used to assess the fairness of the PBI system with respect to VHWs' gender, education level, and village location.Results: In surveys and interviews, supervisors expressed high satisfaction with the PBI system, though some supervisors expressed concerns about possible negative effects from the variation in payments between VHWs and the uncertainty of reward for effort. VHWs perceived the system as generally fair, and preferred it to the previous payment system, but expressed a desire to be paid more. The annual program cost was $516 per VHW, with each VHW covering an average of 115 households. VHWs covering more households tended to earn more. There was some evidence that female gender was associated with higher earnings. Education level and proximity to the district hospital did not appear to be associated with earnings under the PBI system.Conclusions: In a one-year pilot of PBI within a small VHW program, both VHWs and supervisors found the PBI system acceptable and motivating. VHWs with relatively limited formal education were able to master the PBI system. Further research is needed to determine the long-term effects and scalability of PBI, as well as the effects across varied contexts.

KW - Developing countries

KW - Incentives

KW - Low-income countries

KW - Primary health care

KW - Uganda

UR - http://www.scopus.com/inward/record.url?scp=84899479136&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84899479136&partnerID=8YFLogxK

U2 - 10.1186/1478-4491-12-19

DO - 10.1186/1478-4491-12-19

M3 - Article

VL - 12

JO - Human Resources for Health

JF - Human Resources for Health

SN - 1478-4491

IS - 1

M1 - 19

ER -