Financial compensation for CHWs has been, and remains,
a contentious issue, especially in poor countries
where a large number of CHWs are needed [16,17]. While
CHWs are ideally volunteers, in practice, many programmes
have financially rewarded CHWs, even hiring
them as salaried assistants [18,19]. It has been argued that
financial incentives reduce volunteers’ willingness to work
without pay [7] and that such incentives are likely to be
insufficient, leading to high attrition [20,21]. Despite these
issues, both international and national stakeholders have
continued to reaffirm the importance of CHWs, and many
countries have implemented CHW programmes at the
national level, some with remuneration [22-24]. The calls
by local and international stakeholders for expanding the
use of CHWs by 2015 have led to questions about relying
on volunteers to deliver services in poor communities,
with some arguing for greater creativity in the selection,
recruitment and retention of CHWs [25-28].
Though there is consensus that local communities
should be involved in the selection of CHWs, questions
have remained on how that selection should be structured.
A review of studies on CHW programmes noted
that authors state that CHW were “selected by the community”
without showing how this was done [29,30]