Journal Article

Community-based distribution in Tanzania: Costs and impacts of alternative strategies to improve worker performance

Context
Donor funds may be inadequate to support the growing demand for services provided by community-based distribution (CBD) programs. One solution may be to reduce the remuneration of CBD agents, but this approach may lower their productivity. Programs also need to consider reducing other costs, including those for supervision and training.

Methods
The cost per agent visit—including costs associated with payments to agents and to supervisors and the costs of training—was calculated for three CBD programs in Tanzania. The output measure was visits in which contraceptives were provided or referrals made for family planning services. Simulations were used to examine the impact of changes in agent remuneration on costs per visit, assuming different levels of spending on training and supervision.

Results
The program that paid agents the highest annual compensation (US$398) also had the highest costs per agent ($701), but it had the highest number of visits per agent (425). The program that had the lowest annual payments per agent ($33) also had high costs per agent ($558), because its other costs were high and its agents produced few visits (105). The simulations showed that an increase in the amount spent on agent remuneration reduces costs per visit, because the number of agent visits increases, thereby spreading out supervision and training costs over a larger number of visits.

Conclusions
The challenge for CBD programs seeking to reduce their costs is to determine which cost components to decrease so as to minimize any reduction in visits. For example, programs that spend little on compensation might improve their performance by spending more on compensation but less on training or supervision.