Labour conditions in dual-cadre community health worker programmes: a systematic review

“Entonces, Como Promotores, Pues, No Somos Intérpretes”

“…This issue occurs globally. Previous research has revealed that CHWs/ promotores often perform two jobs combined without proper compensation for such work, further exacerbating the dynamic of unpaid or underpaid labor that plagues CHWs/ promotores throughout the globe (Ballard et al, 2023; Closser, 2015; Maes, 2015; Nading, 2013; Van De Ruit, 2019). Issues of remuneration are also intimately connected to gender, as the majority of CHWs/ promotores are women (up to 70 percent globally [Keeru, 2017]) with women more likely to be unpaid for this work (Ballard et al, 2023).…”

“…In our studies, respondents worked two jobs for one salary, compounding the gender pay gap; further underscored by the fact that women earn 82 cents to the dollar that men do in the United States (Aragão, 2023). Issues related to remuneration have been documented in the literature, revealing that CHWs/ promotores sometimes moonlight to make ends meet at the cost of reduced quality of care (Van De Ruit, 2019), protesting for better pay and labor rights (Closser, 2015), and working for low to no pay (Ballard et al, 2023; Maes, 2015; Nading, 2013). States must do more to create the health care infrastructure to sustainably employ CHWs/ promotores so that this critically important workforce is not forced to seek employment elsewhere.…”

Documenting Community Health Worker Compensation Schemes and Their Perceived Effectiveness in Seven sub-Saharan African Countries: A Qualitative Study

“…These findings are consistent with a recent systematic review of dual-cadre CHW programs (i.e., those with both salaried and unsalaried CHWs), which found that unsalaried CHWs frequently reported nonpayment, inadequate or inconsistent payment of incentives, and an overburdensome workload. 7 …”

Health Workforce Shortages and Surpluses: The Case of Unsalaried Workers in Kurdistan Region of Iraq

“…Recently, a scoping review of UHW in Sera Leone showed that the failure to employ UHWs undermines equitable access to healthcare (Pieterse & Saracini, 2023). Other systematic reviews have shown that unsalaried community health workers face exploitation, leading to inadequate provision of health services (Ballard et al, 2023). Another systematic review of lay health workers revealed that they often demand remuneration for their work, although some expressed concerns that payments might undermine their social status as sel ess volunteers (Glenton et al, 2013).…”