Table 3. Factors to be modified when adapting operational design of model community health worker (CHW) costing system to local context.

Factor	Assumption for example model	Condition
		Low	Medium	High
Population density	Low	Rural	Periurban	Urban
Facility density	Low	Rural	Periurban	Urban
Task load	Low	General counselling tasks at household or outreach centres	General counselling and case management tasks at household level, with data reporting	General counselling and case management tasks at household and/or health post level, with data reporting and additional specialized tasks
Education and literacy	Medium–high	None	Primary school	Secondary school
CHW integration with health systema	High	CHW programme works in isolation from health system; links to health system weak	Health system recognizes CHW programme and provides support or guidelines.	Health system provides comprehensive support to CHW programme, including training, supervision, referral, equipment and supplies.
Country ownership and financial supporta	High	CHWs not recognized as part of national system; no financial support provided by government	CHWs recognized as part of health system but role not formalized; little or no financial support provided by government	CHWs recognized as part of health system; partial to full financing by government

^a Functionality definition provided by the Community Health Worker Assessment and Improvement Matrix.³²