External monetary incentive policies for community volunteers: core research protocol for a multi-country study developed during a workshop held from 25-27 July 2006 in Ouagadougou, Burkina Faso

External Monetary' Incentive Policies for Community Volunteers CORE RESEARCH PROTOCOL FOR A MULTI-COUNTRY STUDY Developed during a workshop held from 25-27 July 2006 in Ouagadougou, Burkina Faso African Programme for Onchocerciasis Control (APoC)rl i TABLE OF CONTENTS I. INTRODUCTION......... R,crIoNeLe FoR THE sTUDY........ OpERATIoNAL DEFINtrroNs .................... RrsEencs eUESTIoNS ....................:....... STUDY OBJECTTVES ................ MAIN OBJECTTVE ............. SPECIFIC oBJECTIvES METHODOLOGY....... PRoToCoL DEVELoPMENT WoRKSHoP (25-27 JULY, APoC, oUAGADoucou) . STUDY DESIGN Sruoy Snrs.......... RESEARCH TEAMS Pnr.rgsrn{G oF DATA CoLLECTIoN INSTRUMENTS ................ A DVOCACY/PNT-P TCIO V IS ITS SouRces oF INFoRMATIoN ........... Dete cor-LECTToN Instruments Data collection technique ................. DATA PRoCESSING AND ANALYSIS .............. Qunlrrv coNTRoL MEAsuREs.. ElHlceL CoNslopnartoNs......... '- Ox.cnNrsnrtovon FtnLDwoRK Sruoy LrurtRtroNs................. ScHEDULE ........................ BUDGET PER SITE. ANNEXES...... t.l t.2 1.3 I 2 2 3 3 J 4 4 4 4 4 4 5 5 5 5 5 5 6 6 6 7 8 9 ) 3. 2.t 2.2 4. 5. 3.r 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.8.1 3.8.2 3.9 3.10 3.1 I 3.t2 3.r3 INSTRUMENT I : CHPCKLIST FOR POLICY.MAKERS............. INSTRUMENT 2: CUccKLIST FoR HEeLTH PRoGRAMME MANAGER INSTRUMENT 3: DocuurNT RrvIew GuIoE EXAMPLES oF PRoGRAMues, NGOS, IIN AND DoNon AGENcIES .. SUMMARY TABLE OF RESULTS I ............. SUMMARY TABLE 2................. SUMMARY TABLE 3 -................ SUMMARY TABLE 4................. SUMMARY TABLE 5................. l0 ............ l1 t2 t4 2t 23 25 27 28 29 30 I APOC Asap CDD CDTI EPI HIV/AIDS ITN LGA MOH MoU NGO UNICEF wHo Abbreviations and Acronyms African Programme for Onchocerciasis Control As soon as possible Community-Di rected D istributors of Ivermecti n Community-Directed Treatment with Ivermectin Expanded Programme for Immunisation Human Immunodeficiency virus/Acquired Immunodeficiency Syndrome Insecticide-Treated Net Local Government Area (in Nigeria) Ministry of Health Memorandum of Understanding Non-Governmental Organisation United Nations Children's Fund World Health Organisation l. Introduction l.l Rationale for the study The health services in developing countries are often unable to cope with high demand for health care delivery, thus the increasing dependence on community involvement and the use of volunteers to help provide these services. The organisations involved in community-based programmes, determine the degree and type of community involvement. The communify-directed treatment with ivermectin (CDTI) is a strategy in which communities are responsible for managing and implementing their own prograrnme, selection of community-directed distributors (CDDs) and deciding the q/pe of incentives (monetary and non monetary) to provide to volunteers. CDTI promotes active community participation and decision-making as a means of improving access to the drug and promoting a sense of responsibility, ownership and sustainability (Amazigo et. al. 2002). The CDDs are involved in census, distribution, record keeping and management of side effects. Many are motivated not by monetary incentives but by recognition, self-esteem and skills acquired. Eighfy two percent (82%) of CDDs are involved in additional health and development activities in their communities. Some are reported to be involved in as many as six additional activities (Homeida et.al. 2002; Okeibunor et. Al. 2004). The main activities they were involved in were expanded prograrnme on immunisation (EPI), community development projects, water and sanitation and agriculture. Integration of various community-based programmes will provide opportunities for improved health care delivery and enhance their effectiveness and sustainability (Okeibunor et. al, 20M). Other externally funded control programmes such as EPI, Vitamin A distribution and family planning provide volunteers with monetary incentives. In EPI, the polio eradication programme uses the campaign strategy to improve vaccination coverage and thus the payment of tncenJives-CDDs involved in EPI.were more motivated for EPI activities than for CDTI and other activities they were involved in. This creates problems for volunteers in community-based progranrmes where incentives are not provided (Amazigo et. al. 2002). AIso, CDTI technical project reports from various countries have attributed CDD attrition to monetary incentives provided by other programmes (Okeibunor et. al. 2004). Partners are therefore being encouraged to discontinue provision of incentives. A case study of incentives in the Mali health system reported a dissonant situation in which each programme implemented its own incentive policy. There was a lack of coordination of policy and a considerable dependence on external funds in most of the 14 health prograrnmes supported by various partners (MOH, NGOs and UNICEF) in the country (Remme 2005). According to the study, incentives could therefore affect volunteerism, effectiveness of community involvement, coverage and sustainability. Cameroon has an incentive policy in which volunteers involved in the distribution of Mectizan@ are paid by govemment. There is however, a dearth of information on incentive policies and practices in other countries. To understand the extent of the incentive problem in Nigeria, APOC and National Programme on Immunisation agreed to a joint research study. The idea was later extended to include other APOC countries, namely Cameroon, Ethiopia and Uganda. This multi country study sets out to document the policies of extemal monetary incentives for community volunteers by different health prograflrmes, the determinants of these policies and to what extent they overlap at the implementation level, in the first phase. Based on the outcome of Phase I srudy, a second phase study will be carried out to determine the practices and perceptions at the community level with respect to external monetary incentives. The outcome of these studies could inform policies and practices on incentives for communiry-based programmes. 1.2 OperationalDefinitions Community Health Volunteers: Members of the community who are engaged to perform or offer to perform services at their own free will with or without monetary or in kind incentives. Donors are institutions that voluntarily support funding and may or may not be involved in directprovision ofservices. External Monetary Incentives: rewards/remunerations given to volunteers on ad hoc or regular basis by health and other programs in the form of cash oiin-kind (such as bicycles, motorcycles, radios, ITNs and others) to motivate effort and encourage volunteers to improve and sustain theirperformance in the community. Health Programme: projects or activities organised by MOH, NGOs and other institutions toprovide preventive, curative, promotive or rehabilitative health services to the communitythrough community volunteers. They include health and health related services provided, supervised and regulated by the MOH of a given country. NationaUGeneral Incentives Policies: formal statements of policy developed by governmentthat guides the decisions and actions pertaining to provision of incentives to -community volunteers. Non-Government Organisations (NGOs) are non-profit organisations that are involved inprovision, promotion or supporting the provision of services to the community that are not part ofgovernment bureaucracy, political parties or business community. Programme Incentives Policies: formal statements (written and non-written) of policydeveloped and endorsed at health programs level (MOH, I.iGOr, other institutions) that guide thedecisions and actions pertaining to provision of incentives to community volunteeis. Programme overlap: health programmes are said to overlap when their intervention areas coincide geographically at district (LGA) level. By district, *" *"un the next administrative level after the sub-national one (i.e. National - Regional/provincial - District). 1.3 Research questions What are the policies of different health programmes relating to external monetaryincentives for communify volunteers? What are the determinants of policies of different health programmes relating to external monetary incentives for community volunteers? Where do the policies of different health programmes relating to external monetaryincentives for community volunteers overlap it t[e implementatiJr l;r;ir-' '-' 2 2. Study Objectives 2.1 Main Objective To document the policies on external monetary incentives for community volunteers by different health programmes, the determinants of these policies and to what extent they overlap at the implementation level. 2.2 Specific objectives l. To document any general policy at the national level (states/provinces) on external monetary incentives for community volunteers in the health, HIV/AIDS, agriculture and water sectors. 2. To document the external monetary incentive policies of the different health prograrnmes for community volunteers, including the type, monetary value and frequency of the incentive provided, as well as the involvement of communities in setting these incentives. 3 To determine the rationale for the above policies and the role of donors in influencing these policies. 4 To determine the current and potentiaVfuture overlap of these health programmes in the different districts/LGAs. 5. To determine whether programmes have policies on using volunteers selected for other health programmes and how they deal with incentives in such cases. 6. To document any coordination/harmonisation of incentive policies and practices among different health programmes at national and state/provincial levels. 7. To compare external monetary incentive policies in different countries (existence; range; and uniformity of donors' and programmes' policies). J 3. Methodology 3.1 Protocol Development workshop (25-27 July, Apoc, ouagadougou) lloc organised a protocol development workshop on incentives for I0 participants fromNigeria, cameroon, Erhiopia and Uganda. Sil of the participants came from Nigeria includingtwo representatives from the National lmmunisation P.ogru--e. Other countries had one representative each. 3.2 Study Design This is a two - phased multi-country study that is cross - sectional in desigr. The first phase will concentrate on documenting the existing external monetary incentive poli"i". for the differentcommunity-based prograrunes using community volunteeis in five ApOC-selected countries,namely; Cameroon, Ethiopia, Nigeria and Uganda. The first phase will employ a qualitative approach, using checklists and document reviews. Phase II will be an in-depth study on how incentives policies have been translated into practiceand the perceptions of these incentives by various key players, including the community volunteers. 3.3 Study Sites A total of l0 sites will be involved in the study. Six of these will be fromNigeria selected fromeach geopolitical zone. Cameroon will have 2 sites, one in the Anglophone and the other from theFrancophone province. Ethiopia and Uganda will each have a site. Selection ofsites: - Cameroon: I province per language zone (2). The province is chosen based on the results ofoverlap at the national level (the province with the most overlapping programmes). - Ethiopia: I region is chosen based on the results of overlap aithe national level (the region withthe most overlapping programmes). - Nigeria: I state per geopolitical zone (6). The state is chosen based on the results of overlap at th_e_ national level (the state with the moit overlapping programmes). - Uganda: I region is chosen based the most on the resuits of overlap at the national level (theregion with the most overlapping programmes). 3.4 Research Teams Each study site will hayg a principal investigator (PI), one co-investigator and two researchassistants' Preference will be given to those who have research experience. They will be trainedin data collection techniques and familiarised with the objectives of this study. 15 Pre-testing of data collection instrumentsThe checklist and the document revierv guide rvill be pre-tested before its use for data collection.The pre-test will facilitate^the fine-tuning of the instruments to ensure logical florv of questionsand clarity, as rvellas the feasibiliryof thi proposed merhodology, data collection rechniques andsources of information. 4 3.6 Advocacy/Pre-field visits APOC will formally inform the Ministry of Health (MOH) of the study countries and requesl their cooperation, as well as that of other relevant ministries and government agencies at national and state/provincial levels. The study will commence with consultations between country research teams and relevant staffof ministries of participating countries. The consultations will aim at explaining the significance of this study to key stakeholders in the relevant ministries and solicit their support. 3.7 Sources of information The first phase of this study will collect information from the national and state/province levels. At the national level, responsible staff of Ministries of Health, Agriculture, Water, government agencies, national and international NGOs and donors will be consulted about the existing policies, their rationale as well as interpretations of these policies. However, it should be noted that some community-based programmes may not have national offices and hence there will be a need to get information about them from the state/provincial level. Overall, the first step will be for the country research teams to compile the list of all community - based programmes in the three ministries (Health, Agriculture and Water). This will be followed by identiffing all the different NGOs both national and international either involved or supporting these programmes. The key staff in these different organisations will then be consulted to share their policies regarding the issues of external incentives to volunteers. In addition, a review of all relevant programme documents will be done. 3.8 Data collection 3.8.1 Instruments Checklists (see Annexe I and 2): Two checklists will be used to gather information related to the specific objectives of the study, at the national and state/provincial levels. They will capture the availability and provision of policies. Document review guide (see Annexe 3): A document review guide will be used for the content analysis of the relevant documents, such as policy documents, MoUs, technical reports, work plans, minutes and other materials. 3.8.2 Data collection technique Using the checklists, each PI and co-investigator will collect data from all relevant sources identified in a face-to-face interaction and examination of supporting documents. Data will first be collected at the national level and then at state/provincial levels. 3.9 Data processing and analysis Following data collection, all the checklists will first be cleaned and open-ended responses coded. Data will then be entered using Epi Info and later exported to the SPSS programme for analysis. Logical checks and frequency nms rvill be made on all variables to further the accuracy and consistency of the data and identif any outliers before data analysis. Frequency tables, descriptive statistics, graphs and charts rvill be used to present the findings. Results obtained from the qualitative data w,ill be reported in prose. 5 aa a a 3.10 Quality control measures Quality control is important to ensure quality of the data. In this particular study, it will be achieved through the following; Pre-testing of the instruments. Recruitrnent of research assistants with research experience. Training the research assistants in data collection techniques. Editing of the completed checklists will be done after each successive fieldwork to ensure that the accurate response has been properly recorded. The research assistants will be supervised by the principal investigator, throughout the entire data collection period. The research team will keep field diaries to record study activities. Research team will keep track of refusals and non-response. This should be mirumal and overcome by advocacy. 3.11 EthicalConsiderations The broad and specific objectives of the study as well as the procedures for data collection will bedisclosed to the instirutions/organisations to be studied. Only institutions/organisations that voluntarily agree to participate in the research will be studied. The study will collect information on incentive policies that is publicly available (in principle) and thus not confidential. Each research team will seek government clearance for collecting, analysing and reporting this information. 3.12 Organisation of Fieldwork In conducting the fieldwork, the following steps should be undertaken: l' At National, State/provincial level, ul'sir appropriate ministries (Health, Agriculture andWater) for the list of health, rvater and agriculturul p.og.u*-es using "o--u.iity volunteers.Apply Checklist ^I (see Annex lnstrument l). AIso vrsr't government agencies for a list of their prograrnmes using community volunteers(do not apply Checklist I to these informants). Instruction for each visit: a. Obtain administrative clearanceb. Obtain list of prograrrunes rvith community volunteers ' Use the above list (lb) to vlbr'r all health prograrnmes/agencies using community volunteers and appll'Checklist 2 (see Annex Instrument 2) to each of these prograrrunes. ' Obtain from each programme, the list of its major partners in implementation: IIN agencies, national and International NGOs. a a a 2 J 6 4. Obtain from each prograrrune, the list of its major financial partners (donors). 5. Apply the Checklist 2 (see Annex Instrument 2) to the programme managers in National NGos, International NGos and UN agencies using community volunteers. 6- Apply the Document review guide (see Annex lnstrument 3) to all policy-related documents obtained. 3.13 Study Limitations The'sub-national^study areas \^ere purposively chosen in order to capture the maximum number of programmes at the state/provincial level. The results may therefore be somewhat skewed and not entirely representative. The choice of only one sub-national region/province per country, one state per geopolitical zone (Nigeria) and one province per language zone (Cameroon) means that the study will not be exhaustive. Indeed, this selection may have excluded sites(states/provinces/regions) with other community-based programmes of interest. There may be gaps in the steps to follow to determine which prograrnmes use communify volunteers, as the informants might not know all the prograrnmes concerned (especially non-governmental). Although the focus of the study is on health programmes using community volunteers, a tentative will be made to document which Agriculture and Water programmes also use community volunteers. The biased decision to include these two sectors was based on publications on other development activities in which CDDs were involved (Okeibunor et al. 20M) and on the experience of the participants. Since it was not considered to be feasible to visit all govemment ministries and agencies that might use community volunteers, this decision was made to confine the study to health, with some insight into the Agriculture and Water sectors. Nevertheless, this bias and confinement are limitations in terms of comprehensiveness. a a a 7 o 4. Schedule Activities Deadline I Pre-testin of lnstruments 28 July 2. Final the 29 July 3. Submission of to 3l Jul 4 Approval and slgnlng ofAPW (Agreement for Performance of Work l5 August 5. Recruit team members qqap 6. Advocacy/Administrati ve clearance national and sub-national level asap 7 Releas e of funds check with l0 8 mstruments 9 of team members l0 e I I Data collection at national Ievel 4qap 12. Data collection at ial level End October 14. Data and 15. Data s t6 writi tables 7 Submi ssr on to APOC of S asap asap 15 November I 8 D issemination of resu Its 19. Finalisation of the full _gqepJanuary 8 asap asap asap I 5. Budget per site Per diems Per diems depend on the locality (city/district) where the work is conducted and follow standard WHO per diem guidelines. The per diem for work conducted at the individual's home/resident locality is 50 % of the standard per diem given for that locality. Number of sites Nigeria: I site per geopolitical zone (6) Cameroon: I site per language zones (2) Ethiopia: I site Uganda: I site The total number of sites is l0 9 Activity Type of cost Quantity / Unit(s) Unit Rate/Cost Total CosUsite in USD Advocac y/Adm i n i strati v e clearance (national and sub-national level) and appointments Time Transportation ' (car hire) Communication 2 days *2Pl 2 days 100 130 400 260 500 Reproduce insffuments Photocopying 200 Training. of team members (2+2) T.ime-lPlandlco-PI - 2 assistants Photocopying Stationery 2 2 days days * * 2 2 r00 30 400 t20 100 100 Data collection at national level Time- l PIand I co-PI - 2 assistants Transport 7 days*2 7 days* 2 7 days r00 30 130 1400 420 910 Data collection at state/provincial level Time- I PIand 1co-PI - 2 assistants Transport l0 days*2 l0 days *2 l0 days 50 l5 r30 1000 300 l 300 Data entry and cleaning Time - 2 assistants 5 days *2 15 150 Data Analysis Time - I PI 2 days *l 50 100 Report Writing Time- I PIand I co-PI Stationery/Computer consumables 5 days *2 50 s00 300 Total Study Phase I 8,460 References Amazigo UV, obono M, Dadzie KY et al. (2002) Monitoring community-directed treatmentprogrammes for sustainability: lessons from the African Programme for Onchocerciasis Control(APoc). Annals of Tropical Medicine and parasirology 96 ftuppl. l), s75-s92. Bhattacharyya K, winch P, LeBan K & Tieri M (2001) Community Health worker lncentives and Disincentives: How They Affect Motivation, Retention, and Susiainability. published by theBasic Support for Institutionalizing Child Survival Project (BASICS II). Arlington, Virginia. Homeida M, Braide E, Elhassan E et al. (2002) APoc's strategy of community-directed treatment with ivermectin (CDTI) and its potential for providing additilnal health services to thepoorest populations. African Programme for OnchocerciasG Control. Annals of TropicalMedicine and Parasitology 96, 93-104. o\giuynol JC, ogungbemi MK, Sama M, Gbereou SC, oyene U & Remme JHF (2004)Additional health and development activities for community directed distributors of ivermectin: 1T:"! -or opportunity for onchocerciasis control? Tropical Medicine and International Health 9,887-896. Y'T" MJS (2005) Different Incentive Policies for Community Volunteers, Case Srudy: Mali(Draft), World Bank Country Office Mali. UNICEF^INDP/WorId Bank/WHo Special Programme for Research and Training in TropicalDiseases. (2000) Implementation and Sustainability of community directed trJatment withivermecfin: report of a Multi-country study. Document TDR/IDE/RP/CDTI/00.1. world HealthOrganization, Geneva. UNICEF/LINDPAVorId Bank/WHO Special Programme for Research and Training in TropicalDiseases (2003) The involve-"nt of community-directed distributors of ivermectin in other 1"31!:"0 development activities. Documenr TDR/IDE/CDDV03.l. world Health organization,ueneva. l0 ANNEXES INSTRUMENT I : CgecKLIST FoR PoI-ICy-unKrRS........... INSTRUMENT 2: CUecKLIST FoR HpaITH PnocReuuE MANAGER INSTRUMENT 3: DocuvpNr RTvTg,w GUIDE EXAMPLES oT PnocnavMEs, NGOS, UN nNo DoNoRAGENCIES .. SUMMARY TABLE OF RESULTS 1 ............. SUMMARY TABLE 2......,.......... SUMMARY TABLE 3................. SUMMARY TABLE 4................. SUMMARY TABLE 5................. t2 t4 2t 23 25 27 28 29 30 lt INSTRLJMENT l: Checklist for Policy-makers Respondent: o Appropriate technocrat at the MOH, Mo l{ater, Mo Agriculture and other relevant government agency at thg national level o Equivalent of Director of public health (stare/provincial level) Instruction: i) Fill in checklist. ii) obtain a list of programmes using community volunteers Identification of Project site:(l=Northeast, 2:Northwest, 3=North Central, 4:Southeast, 5:Southwest, 6:SouthSouth, 7=Cameroon A, 8:Cameroon F, 9:Ethiopia, lO:Uganda) Ministry/Agency # (l:Health, 2:Water, 3:Agriculture, 4:Other) Name of Respondent Position List of (health, HIV/AIDS, agricultural and rvater) programmes using community volunteers Introduction: This study sets out to document external monetary incentive policiesprovided by different community-based programmes to communiry ;olunteers. We havedefined external monetary incentives as financial and material incentives provided by aparty external to the community. Any form of cash coming from outside the communityis seen as an external monetary incentive (such as per diJm, travel allowance, stipend, sales revenue, etc). In-kind incentives which .un b. attributed a significant monetary value are also included, such as bicycles, motorcycres, radios, ITNs, etc. The study is an inventory of policies, for which personal opinions from key informants are not solicited. The questions are seeking to determine whether gor.-*.nts have ageneral written or non-written policy on external monetary incentives for community volunteers. t2 Task I. Document (if any) general poliqt at the national level (states/province) on external mondary incentives for community volunteers in the health, HIV/AIDS, agriculture and water sectors. l. Is there a general policy on external monetary incentives for community volunteers at the national level that applies to all community volunteers, irrespective of the programme they are assisting (this includes an explicit policy to not qive external monetary incentives)? o Yes _ (Go on to question 2) o No _ (Go on to question 5) . Don't know _ (Askfor who else can provide this information, stop and start the checklist again with this other resource person) 2. If yes, when was it formulated? 3. By whom was this policy formulated/initiated? 4. What does it prescribe relating to external monetary incentives? (Please askfor evidence of policy availability and provisions. For e.g. MoU, minutes of meeting, offcial letters, reports...). 5. If not, is a policy being formulated? . Yes _ (Please askfor evidence of policy beingformulated, e.g. MoU, minutes of meeting, fficial letters, reports...) o No - (Stop here) o Don't know - (Askfor who else can provide this information, stop and start the checklist agoin with this other resource person) l3 INSTRUMENT 2: Checklist for Heatth programme Manager Respondent: o Head of health programme at national level (MoH, NGos, and agencies)o Head of health programme at state/provincial level (MoH, NGoi agencies) Instruction: i) Fill in checklist. ii) Obtain a list of the programme's donors. iii) obtain a list of implementing rnternational NGos using community volunteers, known to the programme or partnering with the programme.iv) obtain a list of implementing National Ncos using community volunteers, known to the programme or partnering with the programme. Identification of Project site: ( l:Northeast, 2:Northwest, g--rvortt central, 4:southeast, 5:Southwest, 6:southSouth, 7:Cameroon A, 8:Cameroon F, 9:Ethiopia, l0:Uganda) Location ( I :National, 2:State/province) Name of Health Programme/Implementing agency _ Name of Respondent Position Introduction: This study sets out to document external monetary incentive policiesprovided by different community-based programmes to community;olunteers. We havedefined external monetary incentives as finincial and material incentives provided by aparty external to the community. Any form of cash provided to the vllunteer from outside the community is seen as an external monetary incentive (such as per diem, travel allowance, stipend, sales revenue, etc). In-kind incentives which can be attributed a significant monetary value are also included, such as bicycles, motorcycles, radios, ITNs, etc' By community volunteer, we refer to an individual from the community, providing services to histrer own community with or without remuneration. The study is an inventory of policies, for which personal opinions from key informants are not solicited. The questions are seeking to determine whether p.ogru--.s using community volunteers have policies (both *ritten and non-written) on pro"viding external monetary incentives and if so, what these policies stipulate. The .*pli.it pol[y ro norprovide external monetary incentives is also included as a policy (e.g. CDTI). l4 Lkt of programme's financial donor(s) List of partner/known implementing International NGOs using community volunteers List of Partner/known implementing Natianal NGOs using community volunteers Task 2. Document lhe external monetary incentive policies of the health progromme for community volunteers, including the type, monetary value and frequency of the incentive provided. l. Does your prograrlme have a policy on whether to give or to not give extemal monetary incentive to volunteers? o Yes _ (Go on to question j) o No _ (Go on to question 2) o Don't know - (Askfor who else can provide this information, stop and start the checklist again with this other resource person) 2. If No, is a policy being formulated/in process? o Yes _ (Please askfor evidence of policy beingformulated, e.g. MoU, minutes-of meeting, fficial letters, reports, etc. and stop) o No - (Stop here) o Don't know - (Askfor who else can provide this infonnation, stop and ask this question to the other informant) 3. If yes, when was it formulated? 4. By whom was this policy formulated/initiated? 5. What does it prescribe? o External monetary incentives should be given o Extemal monetary incentives should not be given External monetary incentives can be given if found necessary . Any other (specify)... (Please ask for evidence of policy provisions. For e.g. policlt docuntents, pronouncements, MoU, minutes of meeting, technical orfinancial reports, budgets, etc.). l5 6. Type, value and Frequency of external monetary incentives per volunteer 7' Does the policy stipulate that communities are to be involved in setting these external monetary incentives? Yes _No- Don't know 8. If a a a a a (Go to question 8) (Go to question 9) (Askfor who else can provide this information, stop and ask this question again to the other resource person) (Please askfor evidence of this policy. For e.g. policy documents, pronouncements, Mo(J, minutes of meeting, technical orfinanciot ,epoits, bidgets, etc.). yes, how are they to be involved in setting external monetary incentives? , Representatives consulted Representatives signed the MOU Any other (specify). 9' If not, why are they not to be involved in setting external monetary incentives?o Not our donor's policy . Any other reason (specify). Task 3' Determine the rationale for the above policies and the role of donors ininfl uencing these policies. a Moneta Incentives Type of Erternal Amount/ Number Monetery Velue Frequency of incentives Cash Incentive Yes=l No{ Everytime they work Once Per project life Monthly Annually Other Transport Sti Sustenance/Per diem Sales revenue Others In Kind Incentive Radio ITNs Others l0' What are the reasons for having the above external monetary incentive policy? t6 (Please ask for evidence of policy stating the reasons for providing incentives. For e.g.policy documents, guidelines, pronouncements, MoU, minutes of meeting, technical and/or financial reports, budgets, etc.). ll. How have donors played a role in the prograrnme's policy on external monetary incentives? o Convincing programme managers that external monetary incentives are necessary to address certain concerns o Funding conditions o Provide the funds for the incentives o Other (specify) (Please oskfor evidence of this donor role. For e.g. policy documents, pronouncements, MoU, minutes of meeting, technical orfinancial reports, budgets, etc.). Task 4. Determine the current and potential/future geographical overlap of these health programmes in the different districts/LGAs (Definition of district: administrative area below the sub-national (region, province) level: Nation- Region/Province - District. In the case of Nigeria, we are referring to LGAs.) 12. In which districts/LGAs does your health programme currently operate with community volunteers? (List Districts) 13. In which districts/LGAs should your health programme operate in the long run rvith volunteers (endemic districts, need for your programme)? l7 (Also refer to endemicity maps and nature of disease/hearth issue) Task 5: To determine whaher programmes have policies on using volunteers selectedfrom other health progrommes and how thqr deal with incentives in such cases. l4' Do you have a policy on sharing cgmmunity volunteers involved in other healthprogrammes? By this-I mean, does your programme have a policy to use community volunteers that have already been selectea inrough other health programmes, or a policyto share the volunteers selected for your programme with other health programmes? . Yes _ (Go on to question 15) ' No - $top. Go on to task 6 )o Don't know - (Ask for who else can provide this information, stop and start this task of the checklist again with this other resource person) 15. If yes, what does the policy prescribe? (Please ask for evidence of poticy avaitability and provisions e.g. policy documents,guidelines, pronouncements, Mo(/, minutes of meeting, fficial lettirs, tech'nical reports, etc.). 16. Which programme(s) are you sharing health volunteers with? (List the programmesinvolved) 17. Who was involved in formulating the policy guideline? 18. What is the rationale for having or not having the policy? 1.9 D.o you have a policy dealing with extemal monetary incentives for health volunteers shared with other programmes? a a a Yes _No_ Don't know (Go on to question 20) (Stop. Go on to task 6) (Ask for v,ho else can provide this inforntation, stop and start this task of the checklist again with this other resource person) l8 20. lf yes, what does the policy prescribe? (Please ask for evidence of policy provisions. For e.g. policy documents, guidelines, pronouncemenls, MoU, minutes of meeting, olficial letters, technical and/or financial reports, elc.). 21. a. How would you describe the proportion of the incentives contributed by your programme? o More than the other programme(s) o Less than the other programme(s) . Equal contribution b. If yes, how would you describe the type of the incentives contributed by each programme concerned? . Cash (amount per volunteer) o In kind (value per volunteer) Task 6. To document any coordination/harmonisation of incentive policies and practices among different health programmes at national, state and/or district levels. 22. Has your programme discussed your external monetary incentive policies with other health programmes? o Yes _ (Go on to question 23) o No - (Stop here.) o Don't know _ (Ask for who else can provide this information, stop and start this task of the checklist again with this other resource person) 23. If yes, with which health programmes? (Please askfor evidence of these discussions. For e.g. minutes of meeting, fficial letters, etc.). 24. Has your programme harmonised its external monetary incentive policy with other health programmes? o Yes _ (Go on to question 25) o No - (Stop here.) l9 a Don't know 25. If yes, with whom (which health programme(s))? (Ask for who else cctn provide this information, stop and start this task of the checklist again with this other resource person) 26. How have the programmes harmonised these policies? o Joint planning of incentives a J,ornt training incentives (per diems, travel allowances) a Joint incentive package (cash, in a Other arrangements (sp (Please ask for evidence of policy on harmonisation. For e.g. policy documents,g-uidelines, pronouncements, MoU, minutes of meeting, official letters, technical and/orltnanctal reports, etc.). 20 INSTRUMENT 3: Document Review Guide Identification of Project site: _ ( l:Northeast, 2:Northwest, 3=North Central, 4:Southeast, 5=Southwest, 6:South South, 7=Cameroon A, 8=Cameroon F, 9:Ethiopia, l0:Uganda) N ame of Ministry/Implementing partner/llealth Programme Location (1:National, 2:State/province) Issues to be reviewed in the documents for specific objectives 1 to 6: l.a. Availability of (documented and"/or implemented) policy on extemal incentives for community volunteers l.b. If so, what does the policy prescribe? 2.a. Avallability of health programme policy 2.b. Types of incentives 2.c. Monetary value 2.d. Frequency 2.e. Involvement of communities in determining/setting external incentives 3.a. Reasons for external incentive policy 3.b. Influence from donor agency 4.a. Current number of programmes per district/LGA 4.b. Potential/future number of programmes per district/LGA 5.a. Availability of policy to on sharing volunteers 5.b. Provisions of such a policy 5.c. Who was involved in the formulation of this policy? 5.d. Rationale for this policy 5.e. Availability of policy to deal with issue of incentives in such cases 5.f. Provisions of such a policy (each programnes contribution) 6.a. Existence of dialogue with other programmes on coordinationtrarmonisation of incentive policies 6.b. Programmes involved in this dialogue 6.c. Existence of policy for harmonisation rvith other health programmes on incentives 6.d. Programmes involved in this harmonised policy 6.e. Provisions for harmonisation 2l Document Review Template Type of document 2 Subject matter 3 Date 4 Signatories 5 Provisions/content with regard to objective l.a-b 2.a-e 3.a-b 4.a-b 5.a-f 6.a-e 6 Other interesting fi ndings 7 Summary 22 EXAMPLES of Programmes, NGOs, UN and Donor Agencies A. Examples of Programmes that tend to use Community Volunteers: . Onchocerciasiscontrol programme o Tuberculosis and Leprosy control programme . Malaria control prograrnme . Immunisationprogramme r Lymphatic Filariasis elimination prograrnme o Schistosomiasis control programme o Guinea Worm'control programme o Nutrition (Vit.A) prograrnme o Reproductive Health (Child and Matemal Health, Family Planning, Population activities) programme o STI and HIV/AIDS control prograrnme o Water and sanitation programme . Epidemiological SurveillanceilDSR programme o Aglicultural development programmes B. Examples of Major International NGos involved in the above programmes . Sight Savers International o Carter Centre GL 2000 . Sight First Intemational . Rotary'Iaternatironal . Lions Club Intemational . Helen Keller International . Christofell Blinden Mission (CBM) o International Foundation for Education and Self Help (IFESH) . Cooperative Assistance and Relief Everywhere (CARE) . Family Health International (FHI) o AFRICARE . Plan International . PATH . COMPASS o Catholic Relief Service (CRS) o ENHANSE . Medecins Sans Frontieres/Doctors Without Border o Red-Cross . Population Services International . Save the Children C. Examples of UN Agencies involved in the above programmes: o UNICEF o UNFPA o WHO . UNDP 23 o World Bank o FAO D. Examples of other Donor Agencies invotved in the above programmes:o USAID o DFID .EU o CIDA o JICA o French Cooperation . GTZ o Italian Cooperation o Belgium Cooperation o The Netherlands Cooperation (DGIS) o SIDA r DANIDA 24 SUMMARY TABLE OF RESULTS I SITE NAME Indicators related to Specific study objectives S/N VARIABLES Yes No Number o//o 1 Availability of general policy on external incentives 1.a. Availability of general policy on external incentives at MOH 1.b. Availability of general policy on external incentives at MO Agriculture 1.c. Availability of general policy on external incentives at MO Water 2 No. of health programmes using community volunteers 3 No. of health programmes that have policies to give external monetery incentives 4 No. of health programmes that give cash incentives 5 No. of health programmes that give in kind incentives (with monetary value) 6 No. of health programmes that give both cash and in kind incentives (with monetary value) 7 No. of health programmes that have a policy to involve communities in setting external incentives 8 No of health programme rvhere donors influenced incentive policy 9 Number of districts/LGAs rvith overlapping health programmes l0 Average number of overlapping health programmes per district/LGA II Number of districts/LGAs rvith 25 aoYerlapping healthpotential t2 verage number of potential overlapping health programmes A districULGA 13 Ith programmes with policy of using existing No. of hea commu volunteers l4 No. of health programmes with oint external incentive l5 programmes with policy on coordination/ harmonisation of external No of health incentive 26 SUMMARY TABLE 2 SITE NAME Type of External Monetary Incentives S/N Incentive No of programmes o//o I Cesh la Per diem 1b Travel allowance 1c. Stipend 1d. Sales revenue 1e. Other cash 2 In-kind 2a. Bicycles 2b. Motorcycles 2c. Radio 2d. ITN 2e. Others In-kind 27 a SUMMARY TABLE 3 , List of health programmes (incruding HIV/AIDS) using community volunteers, their implementing partners, financial dono.s "and types ofexternal monetary incentives provided Type of External Monetary Incentives Legend:l:Per Diem, 2:Traver Allowance, 3:Stilend, 4=Sares Revenue, 5:other Type ofExternal cash Incentive, 6= Bicycre, 7= Motorcycre, g:Radio, 9=ITN, l0=otherExternal In-kind Incentives SITE NAME SECTOR: HEALTH, inctuding HMAIDS rtnerS/N Name of PROGRAMME National NGO Int. NGO UN agency Financial DONOR TYPE of External Incentive (Enter from 1-10 which IS cableI 2 28 SUMMARY TABLE 4 SITE NAME List of Agriculture programmes using community volunteers SECTOR: AGRICULTURE S/N Name of PROGRAMME I 2 a 29 SUMMARY TABLE 5 SITE NAME List of Water programmes using community volunteers SECTOR: WATER S/N Name of PROGRAMME I 2 i0