Table 2 Key Themes related to the Effects of Removing Performance-Based Financial Incentives on Community Health Workers’ (CHWs) Motivation
CHWs’ Motivation | Perceived Effect | Illustrative Quote |
|---|---|---|
Desire to Perform | Decrease in Desire to Work without Financial Compensation | “Incentives must be there; otherwise you cannot get the job done.” |
Change in Pre- vs Post-Intervention Motivation | “Stopping the incentive after giving them regularly, it is the problem. If the [financial incentive] provision was not there, there might be no trouble.” | |
Household Income Challenges Due to Dependence on Incentives | “They (the volunteer CHWs) consider this money as salary. They are poor people. ‘Earlier we got 500, 700, 1000 taka. Now [we are] getting 200, 150 taka.’ They told us to take care of this issue, at least if it could stay the same.” | |
Level of Effort Expended | Reduction in CHW Visits | “Now, the Shebikas (volunteer CHWs) are reducing the visit count due to the reduction on the incentives from the last 2 months.” |
Perceived Reduction in Quality of Care | “But now, no incentives are given to them. They are not delivering the message properly.” | |
CHW Attrition | “Now they deliver the messages but do not get any incentives, this is [why] the Shebikas (volunteer CHWs) are dropped out.” | |
Substitution of Other Income-Generating Activities | “Shebikas (volunteer CHWs) cannot get anything from here (IYCF counseling). They now focus more on nutritious issues (i.e., selling micronutrient powder … There’s a little more work here.” |