Not only remuneration, but funding for training, supervision and infrastructure support must be ensured.
In addition to the organisational factors like supervision and infrastructure that have been identified in past studies (17), this study reveals that geographical and community-level challenges (classified as external work environment here) may also affect motivation and work performance of female community-level workers.
We thus welcome efforts made in these areas in APEC, including strengthening economic legal infrastructure, supervision of capital markets, corporate governance, and implementation of international financial standards, as exemplified by the work done through the Finance Ministers' process.
Costing considered only diagnosis and antimalarial drugs because the fixed costs (infrastructure, supervision, training and HEWs salaries) were assumed not to differ among the comparative strategies.
Some of the factors identified include leadership and training (e.g. mentoring, continuing education, supervision, monitoring), workplace infrastructure (e.g. buildings, equipment, supplies, reference material) and living conditions (e.g. housing, transportation, relationship with community).
While the methodology allows for unobtrusive observation of provider performance, it does not consider the perspective of the provider or deficiencies in training, infrastructure, supervision or other general areas of support that may be lacking in the provider's work environment.
Especially on larger private ownerships and in areas with limited infrastructure, the supervision of logging activities is necessary to avoid unauthorized or accidental removal of higher-valued trees intended for retention.
Based on the analysis of these factors and lessons learnt from this study, the two concerned departments (health and DWCD) should prioritise corrections in the following areas: ASHA selection, role clarity, training, infrastructure, monitoring, supervision, and incentive systems.
These projects have showed that with proper support for procurement, infrastructure and supervision, Xpert MTB/RIF can be deployed at or very close to the point of care in many settings initially considered difficult because of the hurdles to overcome [ 26].
