Table 7.

Rewarding and sanctioning CHWs

	Strategies	Challenges
Rewarding CHWs “We think that the high performing CHWs should be recognised and awarded. This will make a big difference to how they feel appreciated”. (National decision maker, male, Liberia).	Selecting active CHWs for programme activities where they will be given a financial incentive	Not enough rewards and recognition
	Sharing food or small financial incentives during meetings	Create annual awards, certificates and radio announcement
	Providing verbal praise	Community recognition needs to be stronger in some areas: community members need to support CHWs with their farm work so that they can focus on their health work.
	Assuring CHWs that they have the community’s and God’s recognition
Sanctioning CHWs “You know, it is not easy in our context to manage someone who works voluntarily, and does not benefit from financial incentives. It is just too difficult to objectively manage them”. (Facility manager, female, DRC).	More closely monitoring the CHWs and providing encouragement	Difficult to dismiss poorly performing CHWs
	Providing additional training and support	Time and resource consuming to replace CHWs
	Talking with the community to try to resolve performance problems
	Occasionally, threatening not to submit the CHW report to the facility which would prevent them receiving their allowance.