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Article on Performance Incentives for CHWs making a difference to women's Right to Contraception

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An interesting link to a paper Danny Gotto authored with colleagues and will be presenting APHA Annual Meeting Expo Nov 2-6th in Philadelphia USA: 
https://apha.confex.com/apha/2019/meetingapp.cgi/Paper/439754 

Experience from Western Uganda with CHWs and Performance-Based Incentives: Making Rural Women’s Right to Contraception Real  

Abstract
Background: Ugandan women have a high unmet need for contraception and high levels of unintended pregnancy and unsafe abortion. Community health workers (CHWs) can expand access to family planning by delivering services and linking communities to primary care. This study evaluates a project in which CHWs received performance-based incentives (PBIs) for providing short-term contraception to rural community members, and for referring them to health centers for long-acting or permanent methods (LAPMs).
Methods: We retrospectively collected service delivery data from 10 program and 10 control health centers for 18 months prior to program launch, and the first 18 months of program activity. We used a difference-in-differences approach in which pre-program trends in monthly family planning uptake for control and program health centers were compared to post-program trends using multivariate, negative binomial regression models with fixed effects for health center and time quarters.
Key Findings: 45,421 clients received family planning counseling and services. Each CHW provided contraception to 27 clients/month, including 6 completed LAPM referrals. The program had a significant positive impact on LAPM uptake. Compared to control centers, program centers delivered 2-5 more implants/month (marginal effect=1.8 and 5.1 for Implanon and Jadelle implants respectively, p<0.01) and 3 more tubal ligations/month (marginal effect=5.11, p<0.01). We found no significant change in IUD or short-term methods uptake and inconclusive results for injectables.
Danny Gotto ACODEV & PHM Uganda
Conclusion
CHWs are capable of providing substantial family planning services to rural women. Incentivizing them based on performance and strengthening their links to facility-based providers shows promise for expanding rural access to care.

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