This paper examines the experience with using various incentives to motivate and retain community health workers (CHWs) serving primarily as volunteers in child health and nutrition programs in developing countries. It makes recommendations for more systematic use of multiple incentives based on an understanding of the functions of different kinds of incentives and emphasizes the importance of the relationship between a CHW and community. Case studies from Afghanistan, El Salvador, Honduras, and Madagascar illustrate effective use of different incentives to retain CHWs and sustain CHW programs. Over the past couple decades, a number of studies have shown that community health workers (CHWs) can help reduce morbidity and mortality in certain settings. Health programs have recruited and trained these primarily volunteer workers to carry out a variety of health promotion, case management, and service delivery activities at the community level. CHWs can serve as a bridge between professional health staff and the community and help communities identify and address their own health needs. They can provide information to health system managers that may otherwise never reach them and can encourage those in the health system to understand and respond to community needs. CHWs can help mobilize community resources, act as advocates for the community, and build local capacity.

 Karabi Bhattacharyya, Peter Winch / 2001