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Factors Impacting the Effectiveness of Community Health Worker Behavior Change: A Literature Review (3) Performance-based incentives

HIFA Quotation: 

... We need a universal definition of the term 'performance based finance' or 'performance based incentives' in order to understand better as to how they enhance the motivation of CHWs.

In India, performance based incentives are demotivating the CHWs. 

My understanding (please correct me if I am wrong) is that a performance based payment is made in addition to the salary.

There is a country wide CHW program called the ASHA program in India. This program is a part of the public/government health care services. These CHWs called ASHAs receive only task-based incentives from the government for their work. There is no other payment nor salary for the ASHAs (CHWs). 

Some states do give the ASHAs (CHWs) a set monthly amount and incentives in addition. However the amount varies among these few states as well.

Thus unlike the success stories in other countries, in India, task-based incentives tend to demotivate ASHAs (CHWs) because varying amounts are received every month. Secondly, the status of the ASHAs (CHWs) is not that of the other salaried government employees within the health care system as well as the community.  

Task-based incentives also reduce the bargaining power of the local CHW organisations.  

For detailed analysis please see the reports and studies conducted by myself and other researchers on my website


Date of HIFA message: 
Wednesday, June 22, 2016
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HIFA profile: Kavita Bhatia is an independent researcher in public health. She is based in India. She has considerable experience in the documentation and evaluation of community-based voluntary health care programs, particularly those involving community health workers. Since the past few years, she has been doing research, documentation and advocacy for women community health workers in large scale public health care programs. She is interested in the gender issues, rights and professional development of women health workers. She also runs an e-platform called Ashavani ( She is also a member of the HIFA Working Group on Community Health Workers: Email address: kavbha AT 

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