Date of Award

January 2024

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Debbie Humphries

Second Advisor

Katie Wang

Abstract

IntroductionEquitable compensation of community health workers (CHWs) is fundamental to sustaining and maximizing the impact of CHW interventions worldwide. Despite their pivotal role in promoting health equity especially among underserved populations, CHWs often encounter inadequate and inconsistent compensation, undermining the sustainability and effectiveness of their efforts. This review delves into various CHW compensation models and implications that may improve CHW compensation and performance across diverse patient populations.

MethodsEmploying the Consolidated Framework for Implementation Research (CFIR), this review systematically examines empirical literature to examine six different compensation models: alternative payment methods (value-based, capitation, and shared savings), grant-based, public sector or governmental, volunteer-based, and Medicaid. Through comparative analysis and the CFIR framework constructs, the study assesses factors influencing CHW effectiveness under each compensation model and their potential impacts on global health equity. The analysis focuses on understanding the dynamics between compensation mechanisms, community needs, health system infrastructure, and funding sources to identify actionable insights. Results The impacts of CHWs on health equity is heavily contingent upon context-specific elements such as community needs, health infrastructure, and funding mechanisms. While grant-based models exhibit promise in increasing access and outcomes in underserved regions, their efficacy is impeded by sustainability issues, consistently affecting CHW retention and service delivery. Volunteer models, though beneficial for community engagement and operate on intrinsic motivation, often result in CHW burnout and inconsistent participation. This study identifies financial security, motivation, public recognition of work, and community trust as critical mediators between CHW compensation models and CHW sustainability. Conclusions The compensation of CHWs is an important global issue for advancing health equity across all populations. Policymakers and program designers must consider the intersectional impacts of different compensation strategies to effectively support CHWs, ensuring their ability to contribute to the sustainable and equitable delivery of health services.

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This is an Open Access Thesis.

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