Understanding incentive preferences of community health workers using discrete choice experiments: a multicountry protocol for Kenya, Uganda, Bangladesh and Haiti

INTRODUCTION

There is a renewed global interest in improving community health worker (CHW) programmes. For CHW programmes to be effective, key intervention design factors which contribute to the performance of CHWs need to be identified. The recent WHO guidelines recommends the combination of financial and non-financial incentives to improve CHW performance. However, evidence gaps remain as to what package of incentives will improve their performance in different country contexts. This study aims to evaluate CHW incentive preferences to improve performance and retention which will strengthen CHW programmes and help governments leverage limited resources appropriately.

METHODS AND ANALYSIS

A discrete choice experiment (DCE) will be conducted with CHWs in Bangladesh, Haiti, Kenya and Uganda with different levels of maturity of CHWs programmes. This will be carried out in two phases. Phase 1 will involve preliminary qualitative research including focus group discussions (FGDs) and key informant interviews to develop the DCE design which will include attributes relevant to the CHW country settings. Phase 2 will involve a DCE survey with CHWs, presenting them with a series of job choices with varying attribute levels. An orthogonal design will be used to generate the choice sets for the surveys. The surveys will be administered in locally-appropriate languages to at least 150 CHWs from each of the cadres in each country. Conditional and mixed multinomial logit (MMNL) models will be used for the estimation of stated preferences.

ETHICS AND DISSEMINATION

This study has been reviewed and approved by the Population Council's Institutional Review Board in New York, and appropriate ethics review boards in Kenya, Uganda, Bangladesh and Haiti. The results of the study will be disseminated through in-country dissemination workshops, meetings with country-level stakeholders and policy working groups, print media, online blogs and peer-reviewed journals.

Mow to Assess, Recognize, and Reward Teamwork

Although meaicai practice managers often know a lot about how to reward individual employee performance, they may not be as well versed in the best strategies for rewarding teamwork. However, the most effective employee recognition and rewards programs focus on both individual and team performance. This article describes strategies that practice managers can use to reward teamwork without lessening their employees' desire to perform well individually. It describes five possible goals for a team rewards program and 10 practical tips for assessing and rewarding teamwork. This article also identifies three common concerns about rewarding teamwork and strategies for overcoming those concerns. It describes three types of team rewards programs and discusses when to use continuous and intermittent rewards. This article also offers medical practice managers a reliable five-question survey to use with their employees to assess teamwork and suggests a strategy to encourage employees to recognize the teamwork they observe in one another. Finally, this article explores the importance of the medical practice manager's attitude about team recognition and rewards and suggests what to do when the manager is conflicted about the team rewards he or she must give.

How to avoid 'death by benchmarking'

Hospitals and health systems should adopt four key principles and practices when applying benchmarks to determine physician compensation: Acknowledge that a lower percentile may be appropriate. Use the median as the all-in benchmark. Use peer benchmarks when available. Use alternative benchmarks.

Optimizing enrollment in employer health programs: a comparison of enrollment strategies in the Diabetes Health Plan

BACKGROUND

Many health programs struggle with low enrollment rates.

OBJECTIVES

To compare the characteristics of populations enrolled in a new health plan when employer groups implement voluntary versus automatic enrollment approaches.

STUDY DESIGN

We analyzed enrollment rates resulting from 2 different strategies: voluntary and automatic enrollment. We used regression modeling to estimate the associations of patient characteristics with the probability of enrolling within each strategy. The subjects were 5014 eligible employees from 11 self-insured employers who had purchased the Diabetes Health Plan (DHP), which offers free or discounted copayments for diabetes related medications, testing supplies, and physician visits. Six employers used voluntary enrollment while 5 used automatic enrollment. The main outcome of interest was enrollment into the DHP. Predictors were gender, age, race/ethnicity, dependent status, household income, education level, number of comorbidities, and employer group.

RESULTS

Overall, the proportion of eligible members who were enrolled within the automatic enrollment strategy was 91%, compared with 35% for voluntary enrollment. Income was a significant predictor for voluntary enrollment but not for automatic enrollment. Within automatic enrollment, covered dependents, Hispanics, and persons with 1 nondiabetes comorbidity were more likely to enroll than other subgroups. Employer group was also a significant correlate of enrollment. Notably, all demographic groups had higher DHP enrollment rates under automatic enrollment than under voluntary enrollment.

CONCLUSIONS

For employer-based programs that struggle with low enrollment rates, especially among certain employee subgroups, an automatic enrollment strategy may not only increase the total number of enrollees but may also decrease some enrollment disparities.

Motivating employees through incentives: productive or a counterproductive strategy

The disparity between human resource in health and provision of health services is a growing concern worldwide. Many developing countries are facing this crisis and therefore human resource in health is considered a high priority on their agenda.This imbalance between supplies of human resource is exacerbated by migration of health workers in many countries. Understanding the motivational factor is an important aspect to retain the migrating health workforce. This paper analyses the role of financial and non financial incentives in motivating the health work force. A review of available literature was conducted to understand the role of motivational factor in retaining health workforce. A review of current literature found that an incentive plays a key role in motivating a health worker. Financial incentives are useful in improving the compliance to standard policies and procedures. Comprehensive integrated incentive system approach should be established to develop a sustainable health workforce with required skill. Likewise monetary incentives should be linked to adherence to provincial and national guidelines and procedures. Sustainability could be ensured by commitment of government, political will and involvement of key stakeholders and decision makers.

Oh, wellness

Isn't wellness an annoying word? But as employers, hospitals have many reasons to embrace the concept.

A study of a nursing department performance measurement system: using the Balanced Scorecard and the Analytic Hierarchy Process

The health care industry is under pressure from government and private entities as well as from market conditions to contain costs. In an effort to respond to these pressures, the case hospital in this study implemented a Balanced Scorecard (BSC) in January 2003 and integrated it with the hospital's formal incentive plan for non-physicians in January 2005. The nursing department's performance improved in the 2 years following the introduction of the plan. This study contributes to the literature by demonstrating the performance improvement that results from integrating the BSC with an incentive plan in the nursing field. The results provide insight into the current BSC performance metrics applied by the case nursing department, and could be used as guidelines by other health care organizations that wish to implement BSC-based incentive plans.

A progress report on a department of psychiatry faculty practice plan designed to reward educational and research productivity

OBJECTIVE

The authors provide a progress report on a faculty practice plan that assigns a monetary value to administrative duties, teaching, scholarship, community service, and research.

METHODS

Modifications to the original plan are described and quantifiable results in the areas of scholarship and research are summarized.

RESULTS

During a 4-year period reported, the total direct costs of all grants increased 40% and the total number of publications increased 108% during this same time frame.

CONCLUSION

The authors believe that a practice plan which assigns a monetary value to administrative duties, teaching, scholarship, community service, and research can incentivize faculty to be successful in each of these areas.

"Cooking the books"--behavior-based safety at the San Francisco Bay Bridge

Practitioners of Behavior-Based Safety (BBS) claim dramatic reductions in worker injuries and illnesses through modifying workers' "unsafe behaviors." This case study of a BBS program implemented by KFM, a giant construction consortium rebuilding the eastern span of the San Francisco Bay Bridge in California, documents how BBS was used to suppress reporting of worker injuries and illnesses on site. The key elements of KFM's BBS "injury prevention" strategy included: 1) cash incentives to workers and supervisors who do not report injuries; 2) reprisals and threats of reprisals against those employees who do report injuries; 3) selection and use of employer friendly occupational health clinics and workers compensation insurance administrators; 4) strict limits on the activities of contract industrial hygiene consultants; and 5) a secretive management committee that decides whether reported injuries and illnesses are legitimate and recordable. KFM reported injury and illness rates 55% to 72% lower than other bridge builders in the Bay Area, but the California Division of Occupational Safety and Health (Cal/OSHA) issued Willful citations to the consortium in June 2006 for failing to record 13 worker injuries on its "OSHA Log 300," as required by law.

Recruitment and Retention of Novice Faculty

As nursing faculty members younger than 35, we consider ourselves to be in the minority. Our concern about the future of nursing education has driven us to consider ways to recruit and retain new, young faculty. To stimulate discussion, 10 suggestions for schools of nursing in the recruitment and retention of new faculty are presented: provide guidance, foster socialization, encourage flexibility, conduct orientation, provide support, facilitate collaboration, allow for mistakes, coordinate teaching assignments, grow your own, and offer rewards. While this list is far from complete, we believe it is a starting point from which schools could develop individual strategies for recruitment and retention of faculty members in nursing academia. The nursing shortage continues to intensify the lack of nursing faculty members. As a result, strategies to recruit and retain young faculty members only gain importance. Generations are changing, and it is important that schools of nursing are aware that recruitment and retention strategies that may have been successful in the past, may now be obsolete.

Sales compensation governance: the last frontier of corporate reform

The area of sales compensation has remained relatively untouched by recent pressures for compensation reform. This article highlights some of the ways that sales organizations stumble in managing their compensation programs, and why it takes more than a simple tactical fix to address these problems effectively. The authors describe a more structured governance framework that not only identifies and resolves key sales compensation issues, but ultimately safeguards the effectiveness and financial integrity of the sales organization itself.