Table 3. Summary of evidence of effectiveness of types of performance-based incentives for community health workers in low- and middle-income countries.

Type of performance-based incentive	Mechanism of incentive	Why incentive worked	Countries
What incentives worked?
Financial	Providing performance payments to both CHWs and their supervisors	Complementary efforts from CHWs to supply services and from supervisors raised demand for services35	Sierra Leone
	Pairing performance payments with complementary demand-side information	Incentives for Anganwadi workers and information for mothers resulted in better communication and the incentivized workers made more home visits to monitor healthy cooking31–33	India
Non-financial	Team-based goals and targets	Incentives supported intrinsic motivation and team cohesion29,37	El Salvador, India
	Boosting social status of CHWs by awarding certificates and rewards in public ceremonies and meetings	Incentives can reinforce intrinsic motivation of CHWs and families’ support of CHWs29,38 Incentives can promote community recognition and appreciation of CHWs37	El Salvador, Guinea-Bissau, India
	Facilitating peer comparison among CHW	Incentives can encourage effort or help CHWs to assess what is expected of them36	India, Zambia
What incentives did not work?
Financial	Small performance payments to CHWs	On aggregate, low financial incentives were not sufficient to motivate additional effort by CHWs30,36	Rwanda, Zambia
	Limited control over incentivized tasks	Incentivized tasks perceived to be outside the control of CHWs reduced their effort and may have led to unrewarded tasks being neglected28 For CHW cooperatives, performance depended on the unobservable efforts of the other cooperative members30	India, Rwanda
	Complex rules around the disbursement of performance-based incentives	CHWs reported confusion about the payment mechanisms (which were intended to encourage team and individual effort)30	Rwanda
	Selling products to known impoverished households	CHWs reported feeling embarrassed and socially penalized, which resulted in lower effort34	Uganda
	Providing performance payments for a subset of CHW activities	CHWs reallocated their effort towards the rewarded task to the detriment of other unrewarded activities28,39 CHWs focused their effort on supporting community members closest to the target measure, at the expense of other tasks32,33	India, Pakistan

CHW: community health worker.