Motivation and Performance of Community Health Workers: Nothing New Under the Sun, and Yet…

Key Messages We consider the types of incentives that motivate community health workers9 (CHWs) performance and the implications at 2 levels of systems analysis—first, for CHWs themselves and then for appropriate management of an invaluable human resource by CHW programs. The World Health Organization recommendations on commensurability of CHW compensation with the job demands—and corresponding professionalization—represent the culmination of decades of work, advances, forgetfulness, rediscovery, collective wisdom, and available evidence. Tapping into communities9 own organizing potential through volunteerism is, however, a force in both high-income and low- and middle-income countries. We offer predictions for the future direction of CHW programs: National CHW programs—whether implemented by states or non-state partners—will be a growing opportunity to viably strengthen national health systems. Partnerships between state and non-state actors will be key to sustain effective CHW programs in national PHC strategies at scale. The social-versus-institutional anchoring of CHW programs will be an enduring challenge for their performance and sustainability. Dual models (paid CHWs and volunteers), if ethically managed, will be a promising approach for efficiency and scale.