Community Health Workers should be paid for their efforts

Community Health Workers should be paid for their efforts. CHWs are trained to carry out essential care, often under very difficult circumstances. Furthermore, CHWs’ role in identifying patients in need of care and in ensuring adherence to treatment results in significant short- and long-term cost savings through earlier initiation of treatment and by preventing or delaying the emergence of drug resistant-disease. They should not be asked to volunteer their services in settings of great poverty. Rather, their efforts should be fairly compensated. Salarying CHWs in settings with high unemployment and overall poverty helps jump-start economic activity in addition to being a critical recognition of the vital services they provide.

How the payment is calculated

In determining how much to pay CHWs, it is important to keep in mind local pay scales for public sector employees, from schoolteachers to staff at health facilities. When a new CHW program is established in an area where community health workers already exist, the payment for both groups should be harmonized as much as possible.

Other considerations include the extent and scope of the CHW role, including whether the job duties are considered part-time or full-time. Some programs provide a flat fee to CHWs (example: payment at PIH’s program in Haiti), while other programs pay different salaries depending on the number of households served and the number of visits the CHWs make to the health centers (example: payment at PIH’s program in Rwanda).

The CHWs are paid monthly at the health center by a designated staff member. At Inshuti Mu Buzima in Rwanda, the community health nurse disburses payments. At Zanmi Lasante in Haiti, the accountant is responsible for the CHW payments.