Limits...
Reservation wage of female volunteer community health workers in Dhaka urban slums: a bidding game approach.

Alam K, Tasneem S, Huq M - Health Econ Rev (2014)

Bottom Line: This results challenges for the cost effectiveness and sustainability of the urban health program.So, the study has implications in improving retention of health workers as well as their level of performance.The study also suggests that the financial incentives provided to CHWs should be clearly based on their qualifications and opportunity cost to ensure a high performing and motivated health workforce.

View Article: PubMed Central - PubMed

Affiliation: Equity and Health Systems, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), 68 Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh, khurshid@icddrb.org.

ABSTRACT

Background: BRAC, a large Bangladeshi NGO, recently has been using female volunteer community health workers (CHWs) in Dhaka urban slums to provide maternal and child health services. Due to erratic performance-based income and higher opportunity cost the urban CHWs lose motivation which contributes to high dropout and poor performance. This results challenges for the cost effectiveness and sustainability of the urban health program. CHWs also consider their performance-based income very low compare to their work load. So, CHWs raise their voice for a fixed income. In order to understand this problem we explored fixed income for CHWs and the correlates that influence it. We surveyed a sample of 542 current CHWs. We used bidding game approach to derive the equilibrium reservation wage for CHWs for providing full-time services. Then, we performed ordered logit models with bootstrap simulation to identify the determinants of reservation wage.

Results: The average reservation wage of CHWs to continue their work as full-time CHWs rather than volunteer CHWs was US$24.11 which was three times higher than their current performance-based average income of US$ 8.03. Those CHWs received additional health training outside BRAC were 72% and those who joined with an expectation of income were 62% more likely to ask for higher reservation wage. On the contrary, CHWs who were burdened with household loan were 65% and CHWs who had alternative income generating scope were 47% less likely to ask for higher reservation wage. Other important factors we identified were BRAC village organization membership, competition with other health services providers, performance as a CHW, and current and past monthly CHW income.

Conclusions: The findings of this study are relevant to certain developing countries such as Bangladesh and Tanzania which commonly use volunteer CHWs, and where poor retention and performance is a common issue due to erratic and performance-based income. So, the study has implications in improving retention of health workers as well as their level of performance. The study also suggests that the financial incentives provided to CHWs should be clearly based on their qualifications and opportunity cost to ensure a high performing and motivated health workforce.

No MeSH data available.


Predicted values of three outcomes (inactive, moderately active and active BRAC female volunteer CHWs), Dhaka urban slums, 2008.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4502072&req=5

Fig2: Predicted values of three outcomes (inactive, moderately active and active BRAC female volunteer CHWs), Dhaka urban slums, 2008.

Mentions: Table 5 shows marginal effect of the explanatory variables of our model. The results suggest that marginal effect of almost all the explanatory variables in the model had a lower magnitude for the reservation wage of moderately active CHW group whereas it had higher magnitude for the reservation wage of inactive and active CHWs groups. It might imply that a larger fraction of variations in wage level could be explained by the explanatory variables in higher and lower level of fixed reservation wage ranges. We found the effect of outside health training the strongest in absolute value and it increased the likelihood to be in the highest reservation wage group by 18.1% (significant at 5% level) but decreased the likelihood to be in the lowest reservation group by 15% (significant at 5% level). We observed similar trends for the variable of ‘VO membership’ (11% vs.10.4%, significant at 5% level) and ‘joined as a CHW with an expectation of income’ (14.6% vs.15%, significant at 5% level). However, it also suggests that household loan and alternative income generating scope reduced the likelihood to be in the highest reservation wage group by 15.1% and 10.9% (significant at 5% level) respectively. Figure 2 depicts the predictions of the occurrence of outcomes with special attention to outcome 1 (moderately active CHW group) which is more likely the average choice of Manoshi CHWs.Table 5


Reservation wage of female volunteer community health workers in Dhaka urban slums: a bidding game approach.

Alam K, Tasneem S, Huq M - Health Econ Rev (2014)

Predicted values of three outcomes (inactive, moderately active and active BRAC female volunteer CHWs), Dhaka urban slums, 2008.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4502072&req=5

Fig2: Predicted values of three outcomes (inactive, moderately active and active BRAC female volunteer CHWs), Dhaka urban slums, 2008.
Mentions: Table 5 shows marginal effect of the explanatory variables of our model. The results suggest that marginal effect of almost all the explanatory variables in the model had a lower magnitude for the reservation wage of moderately active CHW group whereas it had higher magnitude for the reservation wage of inactive and active CHWs groups. It might imply that a larger fraction of variations in wage level could be explained by the explanatory variables in higher and lower level of fixed reservation wage ranges. We found the effect of outside health training the strongest in absolute value and it increased the likelihood to be in the highest reservation wage group by 18.1% (significant at 5% level) but decreased the likelihood to be in the lowest reservation group by 15% (significant at 5% level). We observed similar trends for the variable of ‘VO membership’ (11% vs.10.4%, significant at 5% level) and ‘joined as a CHW with an expectation of income’ (14.6% vs.15%, significant at 5% level). However, it also suggests that household loan and alternative income generating scope reduced the likelihood to be in the highest reservation wage group by 15.1% and 10.9% (significant at 5% level) respectively. Figure 2 depicts the predictions of the occurrence of outcomes with special attention to outcome 1 (moderately active CHW group) which is more likely the average choice of Manoshi CHWs.Table 5

Bottom Line: This results challenges for the cost effectiveness and sustainability of the urban health program.So, the study has implications in improving retention of health workers as well as their level of performance.The study also suggests that the financial incentives provided to CHWs should be clearly based on their qualifications and opportunity cost to ensure a high performing and motivated health workforce.

View Article: PubMed Central - PubMed

Affiliation: Equity and Health Systems, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), 68 Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh, khurshid@icddrb.org.

ABSTRACT

Background: BRAC, a large Bangladeshi NGO, recently has been using female volunteer community health workers (CHWs) in Dhaka urban slums to provide maternal and child health services. Due to erratic performance-based income and higher opportunity cost the urban CHWs lose motivation which contributes to high dropout and poor performance. This results challenges for the cost effectiveness and sustainability of the urban health program. CHWs also consider their performance-based income very low compare to their work load. So, CHWs raise their voice for a fixed income. In order to understand this problem we explored fixed income for CHWs and the correlates that influence it. We surveyed a sample of 542 current CHWs. We used bidding game approach to derive the equilibrium reservation wage for CHWs for providing full-time services. Then, we performed ordered logit models with bootstrap simulation to identify the determinants of reservation wage.

Results: The average reservation wage of CHWs to continue their work as full-time CHWs rather than volunteer CHWs was US$24.11 which was three times higher than their current performance-based average income of US$ 8.03. Those CHWs received additional health training outside BRAC were 72% and those who joined with an expectation of income were 62% more likely to ask for higher reservation wage. On the contrary, CHWs who were burdened with household loan were 65% and CHWs who had alternative income generating scope were 47% less likely to ask for higher reservation wage. Other important factors we identified were BRAC village organization membership, competition with other health services providers, performance as a CHW, and current and past monthly CHW income.

Conclusions: The findings of this study are relevant to certain developing countries such as Bangladesh and Tanzania which commonly use volunteer CHWs, and where poor retention and performance is a common issue due to erratic and performance-based income. So, the study has implications in improving retention of health workers as well as their level of performance. The study also suggests that the financial incentives provided to CHWs should be clearly based on their qualifications and opportunity cost to ensure a high performing and motivated health workforce.

No MeSH data available.