Historically, scaled CHW programs have suffered from significant attrition over time and low productivity [
2], with several reasons cited including inadequate attention to CHW concerns about their pre-service training, supervisory support, financial and non-financial incentives, satisfaction with their role, and professional development opportunities [
25,
40]. As with other cadres of workers, CHWs’ incentive satisfaction is closely linked to their motivation, but research on this matter continues to be piecemeal, small in scale, and contextual, with limited generalizability [
25,
41,
42]. Existing research suggests that formal salaries for a large cadre of CHWs may be financially unsustainable at a national scale in most low- and some middle-income countries; however, a combination of financial and non-financial incentives such as t-shirts/caps, other social recognition, certifications, resource availability, and positive working relationships may improve CHW motivation and reduce attrition [
23,
40,
41,
43]. The ethical dimensions of asking CHWs to volunteer their time need to be considered, and more research is needed on an appropriate combination of these incentives (appropriate training/certification, career opportunities, social recognition, performance-based financing, allowance and salaries) which could be applicable across contexts and commensurate with their job demands [
6,
23,
26‐
28,
34,
40,
42,
44]. Further research is also needed on payment systems that could reward accountability [
32]. This information needs to be contextualized to specific country settings to understand what levels, methods, and types of incentives are cost-effective, given a country’s gross domestic product (GDP) and health expenditure trends [
16,
43]. These results need to be disaggregated by gender, and more research is needed on meeting the needs of, in some cases, a predominantly female CHW workforce [
21,
28]. Incentives’ effects on CHWs’ motivation, as well as their effects on performance and patient outcomes, have scarce empirical evidence [
23,
31].
Attention also needs to be paid to the risk of exploiting CHWs, particularly women [
2]. The emphasis on achieving Sustainable Development Goals (SDGs) and universal health care (UHC) has resulted in expanded CHW roles beyond health care, across a variety of sectors including education and agriculture; however, limited progress has been made in institutionalizing compensatory mechanisms for their time.