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首页> 外文期刊>Pilot and Feasibility Studies >Assessing the feasibility and acceptability of a financial versus behavioural incentive-based intervention for community health workers in rural Indonesia
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Assessing the feasibility and acceptability of a financial versus behavioural incentive-based intervention for community health workers in rural Indonesia

机译：评估金融与行为激励为基于行为激励干预的可行性和可接受性，在印度尼西亚农村的社区卫生工作者中

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BackgroundThe World Health Organization recommends that community health workers (CHWs) receive a mix of financial and non-financial incentives, yet notes that there is limited evidence to support the use of one type of incentive (i.e. financial or non-financial) over another. In preparation for a larger scale trial, we investigated the acceptability and feasibility of two different forms of incentives for CHWs in Malang District, Indonesia.MethodsCHWs working on a cardiovascular disease (CVD) risk screening and management programme in two villages were assigned to receive either a financial or non-financial incentive for 6?months. In the financial incentives village, CHWs (n = 20) received 16,000 IDR (USD 1.1) per patient followed up or 500,000 IDR (USD 34.1) if they followed up 100% of their assigned high-risk CVD patients each month. In the non-financial incentive village, CHWs (n = 20) were eligible to receive a Quality Care Certificate for following up the highest number of high-risk CVD patients each month, awarded in a public ceremony. At the end of the 6-month intervention period, focus group discussions were conducted with CHWs and semi-structured interviews with programme administrators to investigate acceptability, facilitators and barriers to implementation and feasibility of the incentive models. Data on monthly CHW follow-up activity were analysed using descriptive statistics to assess the preliminary impact of each incentive on service delivery outcomes, and CHW motivation levels were assessed pre- and post-implementation.ResultsFactors beyond the control of the study significantly interrupted the implementation of the financial incentive, particularly the threat of violence towards CHWs due to village government elections. Despite CHWs reporting that both the financial and non-financial incentives were acceptable, programme administrators questioned the sustainability of the non-financial incentive and reported CHWs were ambivalent towards them. CHW service delivery outcomes increased 17% for CHWs eligible for the non-financial incentive and 21% for CHWs eligible for the financial incentive. There was a statistically significant increase (p < 0.0001) in motivation scores for the performance domain in both villages.ConclusionIt was feasible to deliver both a performance-based financial and non-financial incentive to CHWs in Malang District, Indonesia, and both incentive types were acceptable to CHWs and programme administrators. Evidence of preliminary effectiveness also suggests that both the financial and non-financial incentives were associated with improved motivation and service delivery outcomes. These findings will inform the next phase of incentive design, in which incentive feasibility and preliminary effectiveness will need to be considered alongside their longer-term sustainability within the health system.
机译：背景技术世界卫生组织建议社区卫生工作者（CHWS）收到金融和非财务激励的组合，但指出的说明证据有限，以支持使用一种类型的激励（即财务或非财务）。在准备更大的规模试验时，我们调查了两种不同形式的Chws在印度尼西亚的Chws奖励的可接受性和可行性。在两个村庄的心血管疾病（CVD）风险筛查和管理计划中致力于接受6个月的财务或非财务激励。在金融激励村，CHW（n = 20）每位患者收到16,000个IDR（1.1美元），如果他们每月随访100％的可分配的高风险CVD患者，则为500,000 IDR（34.1美元）。在非金融激励村，CHWS（n = 20）有资格在公共仪式中授予追随最高的高风险CVD患者数量的优质护理证明。在6个月的干预期结束时，焦点小组讨论是通过CHW和半结构化访谈进行的，方案管理员进行了计划，以调查可接受性，协调人员和激励模型的可行性的障碍。使用描述性统计分析每月CHW后续活动的数据，以评估每个激励措施对服务交付结果的初步影响，并评估CHW动力水平预先和实施后。遗传性因素超出了对研究的控制，显着打断了实施财务激励，特别是由于村政府选举而对CHW的暴力威胁。尽管CHWS报告说，财务和非金融激励措施都是可接受的，方案管理员质疑非财务激励的可持续性，报告的CHWS对他们矛盾。 CHW服务交付结果增加了17％，因为CHW有资格获得非财务激励，21％的CHW有资格获得财务激励。在两个村庄的绩效领域的动机分数存在统计上显着的增加CHW和计划管理员可以接受。初步效力的证据也表明，金融和非金融激励措施都与改善的动机和服务交付结果有关。这些调查结果将通知下一阶段的激励设计，其中促进可行性和初步效益将需要考虑在卫生系统内的长期可持续性。

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