Volunteer community health workers (CHWs) are one approach to addressing the health workforce crisis
in developing countries. BRAC, a large Bangladeshi NGO, a pioneer in this area, uses female volunteer
CHWs as core workers in its health programs. After 25 years of implementing the CHW model in rural
areas, BRAC has begun using female CHWs in urban slums through its community-based mother,
newborn and child health interventions. However, the program experienced suboptimal performance
among CHWs, with a high percentage of them remaining in their positions but becoming “inactive”, not
truly participating in daily community health activities. This suggests a need to better understand the
relative importance of factors affecting their active participation and to recommend strategies for
improving their participation. This mixed-method study included a descriptive correlational design to
assess factors relating to level of activity of CHWs and focus group discussions to explore solutions to
these problems. A sample of 542 current female CHWs from project areas participated in the survey.
Financial incentives were the main factor linked to the activity of CHWs. CHWs who thought that
running their families would be difficult without CHW income had more than three times greater odds to
become active. In addition, social prestige and positive community feedback to the CHWs were important
non-financial factors associated with level of activity. In order to improve volunteer CHWs’
performance, a combination of financial and non-financial incentives should be used.