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Objective To review the evidence on the impact on measurable outcomes of performance-based incentives for community health workers (CHWs) in low- and middle-income countries. Methods We conducted a systematic review of intervention studies published before November 2020 that evaluated the impact of financial and non-financial performance-based incentives for CHWs. Outcomes included patient health indicators; quality, utilization or delivery of health-care services; and CHW motivation or satisfaction. We assessed risk of bias for all included studies using the Cochrane tool. We based our narrative synthesis on a framework for measuring the performance of CHW programmes, comprising inputs, processes, performance outputs and health outcomes. Findings Two reviewers screened 2811 records; we included 12 studies, 11 of which were randomized controlled trials and one a nonrandomized trial. We found that non-financial, publicly displayed recognition of CHWs' efforts was effective in improved service delivery outcomes. While large financial incentives were more effective than small ones in bringing about improved performance, they often resulted in the reallocation of effort away from other, non-incentivized tasks. We found no studies that tested a combined package of financial and non-financial incentives. The rationale for the design of performance-based incentives or explanation of how incentives interacted with contextual factors were rarely reported. Conclusion Financial performance-based incentives alone can improve CHW service delivery outcomes, but at the risk of unincentivized tasks being neglected. As calls to professionalize CHW programmes gain momentum, research that explores the interactions among different forms of incentives, context and sustainability is needed. Objectif Examiner les preuves attestant de l'impact des incitants lies aux performances sur les resultats mesurables des agents de sante communautaires (ASC) dans les pays a faible et moyen revenu. Methodes Nous avons effectue une revue systematique des etudes d'intervention publiees avant novembre 2020 et evaluant l'impact, sur les ASC, des incitants financiers et non financiers lies aux performances. Les resultats observes concernaient notamment les indicateurs de sante des patients; la qualite, l'utilisation ou la fourniture de soins de sante; et le degre de motivation ou de satisfaction des ASC. Nous avons employe l'outil Cochrane afin de calculer le risque de biais pour toutes les etudes selectionnees. Notre synthese narrative repose sur un cadre mesurant les performances des programmes d'ASC, en ce compris les moyens disponibles, les processus et les resultats en termes de performances et de sante. Resultats Deux reviseurs ont passe au crible 2811 documents; nous avons retenu 12 etudes, dont 11 essais randomises controles et un essai non randomise. Nous avons constate que le fait d'afficher ouvertement une reconnaissance non financiere des efforts consentis par les ASC entrainait une amelioration des prestations de service. En outre, bien que l'efficacite des incitants financiers soit proportionnelle au montant octroye lorsqu'il s'agissait d'obtenir de meilleures performances, cette evolution se faisait souvent aux depens des taches ne donnant pas droit a des mesures incitatives. Nous n'avons trouve aucune etude ayant teste un ensemble d'incitants financiers et non financiers. La logique derriere la conception des incitants lies aux performances ou l'explication des interactions entre incitants et facteurs contextuels n'etaient que rarement communiques. Conclusion Les incitants financiers lies aux performances suffisent a ameliorer les prestations des ASC, mais risquent de detourner l'attention des taches ne faisant pas l'objet d'incitants. De plus en plus de voix s'elevent pour reclamer une professionnalisation des programmes d'ASC; il devient donc essentiel de mener des recherches afin d'explorer les interactions entre les differentes formes d'incitants, le contexte et la perennisation. Objetivo Revisar la evidencia sobre el impacto en los resultados medibles de los incentivos basados en el rendimiento para el personal sanitario comunitario (PSC) en paises de ingresos bajos y medios. Metodos Se realizo una revision sistematica de los estudios de intervention, publicados antes de noviembre de 2020, que evaluaban el impacto de los incentivos financieros y no financieros basados en el rendimiento para el PSC. Los resultados incluyeron indicadores de salud de los pacientes; calidad, utilization o prestacion de servicios de atencion sanitaria; y motivation o satisfaction del PSC. Se evaluo el riesgo de sesgo para todos los estudios incluidos mediante Cochrane. La sintesis narrativa se baso en un marco para medir el rendimiento de los programas de PSC, que comprende aportaciones, procesos, resultados de rendimiento y resultados de salud. Resultados Dos revisores examinaron 2811 informes; se incluyeron 12 estudios, 11 de los cuales eran ensayos controlados aleatorios y uno no aleatorio. Se encontro que el reconocimiento no financiero, mostrado publicamente, de los esfuerzos del PSC fue efectivo para mejorar los resultados de la prestacion de servicios. Si bien los incentivos financieros grandes fueron mas eficaces que los pequenos para lograr un mejor rendimiento, a menudo dieron lugar a la reasignacion de esfuerzos de otras tareas no incentivadas. No encontramos ningun estudio que probara un paquete combinado de incentivos financieros y no financieros. Rara vez se informo de la justification del diseno de los incentivos basados en el rendimiento o de la explication de como los incentivos interactuaban con los factores contextuales. Conclusion Los incentivos financieros basados en el rendimiento por si solos pueden mejorar los resultados de la prestacion de servicios del PSC, pero con el riesgo de que se descuiden las tareas no incentivadas. A medida que los llamamientos a la profesionalizacion de los programas de PSC cobran impulso, es necesario realizar investigaciones que exploren las interacciones entre las diferentes formas de incentivos, el contexto y la sostenibilidad., Introduction Community health workers (CHWs) play an important role in fulfilling global commitments to strengthen primary health-care systems and achieve universal health coverage. A CHW is a member of the [...]

Internationally, there is an urgent need to understand factors promoting successful settlement and integration of people with forced or voluntary migration experiences (i.e., refugee and non-refugee migrants). This paper provides a protocol of a mixed-methods investigation of contextual factors of successful settlement and service utilization of youth and their families, as young people could be at higher risk due to stressors associated with pre-migration trauma, post-migration settlement stressors, and adolescent development. This large-scale mixed-methods study will be conducted across three countries. A questionnaire survey will seek responses from 1200 youth aged 15–24 years residing in South Australia, Ontario, Canada, and California, United States of America. The qualitative component of the study will comprise 54 focus groups (324 participants) with youth and their parents/caregivers. The study design allows a range of important phenomena (e.g., different migration pathways and settlement countries) and key questions (e.g., regarding the intersection of migration, settlement, and wellbeing) to be addressed. It also allows for generalizability of findings to be tested across different communities and countries. Findings will support recommendations for policy and practice and may be generalized to advance research with youth and their families. This study is one of the largest, most comprehensive studies of youth settlement. [ABSTRACT FROM AUTHOR]