A Systematic Review of Performance-Based Incentives for Community-Directed Distributors and Ivermectin Coverage for Onchocerciasis in Ghana's Bono Region, 2006

Onchocerciasis remains a public health challenge in Ghana. Community-directed distributors are central to the mass drug administration of ivermectin. The use of performance-based incentives to motivate these volunteers is a common strategy, but its specific impact on treatment coverage in Ghana’s Bono Region requires systematic evaluation. This systematic review aimed to synthesise existing evidence on the impact of performance-based incentives for community-directed distributors on ivermectin treatment coverage for onchocerciasis in the Bono Region of Ghana. A systematic search of multiple electronic databases and grey literature sources was conducted. Studies were screened against pre-defined inclusion criteria. Data were extracted and the methodological quality of included studies was appraised using appropriate tools. A narrative synthesis was performed due to heterogeneity in study designs and reported outcomes. The review identified a limited number of relevant studies. The available evidence suggests that performance-based incentives were associated with improved ivermectin coverage. One study reported a coverage increase following the introduction of a targeted incentive scheme. Evidence on the long-term sustainability and cost-effectiveness of such programmes was scarce. Performance-based incentives may improve ivermectin coverage delivered by community-directed distributors in the Bono Region. The current evidence base is insufficient to draw definitive conclusions regarding long-term impact or optimal incentive design. Further robust, longitudinal research is needed to evaluate the sustainability and equity impacts of incentive models. Programme planners should consider piloting and rigorously evaluating context-specific incentive schemes before wide-scale implementation. onchocerciasis, ivermectin, mass drug administration, community-directed distributors, performance-based financing, incentives, Ghana, systematic review This review consolidates the available evidence to inform policy discussions on motivating community health workers within onchocerciasis control programmes.