Discrete choice experiments (DCE) were conducted to provide an understanding of preferences of key individuals (e.g., patients, clients, health workers). The method employed involved asking individuals to state their preferences in regard to hypothetical alternative scenarios or sets of services. Each alternative was described by several attributes (e.g., packages of services, types of incentives, workload or other work conditions, type of training). The experiment assessed various stakeholder preferences using best-worst scaling methods. The answers were used to assess whether preferences are significantly influenced by the specific attribute, and to assess their relative importance. This was expected to allow planners and decision-makers to better consider the desirability and potential feasibility of different program design options.
For the CHW DCE, the purpose was to identify the characteristics of a CHW program that would recruit, retain and motivate CHWs, while assessing the trade-offs for various levels of workload, monetary and non-monetary incentives and responsibilities. The results of the DCE on opinions of CHWS, would allow development of policies that are evidence-based and reflective of the preferences of CHWs.
The DCE recommended that:
1.Prospective CHWs should be selected by community governing structures and should be trained on a comprehensive package of health services.
2.Trained CHWs should be paid a fixed and recurring wage.
3.The MoHCDGEC should establish a clear accountability system that targets supervisory mechanisms at both the health facility level and local governing structures.
Discrete choice experiment on governance of CBHP
This discrete choice experiment follows the same basic methodology as the DCE on CHW designs, but would focus on the options for how CBHC schemes can be governed at the local level. This inquiry outlined the basic attributes and options surrounding how to provide sustainable accountability and support to CHWs at the local level, and identify consideration of the roles of village health committees, local government authorities, health management teams, MOHCDGEC health facility managers, NGOs, and other arrangements