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

Context: Donor funds may be inadequate to support the growing demand for se rvices provided by community-based distribution (CBD) programs. One solutio n may be to reduce the remuneration of CBD agents, but this approach may lo wer 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 t hree CBD programs in Tanzania. The output measure was visits in which contr aceptives were provided or referrals made for family planning services. Sim ulations were used to examine the impact of changes in agent remuneration o n costs per visit, assuming different levels of spending on training and su pervision. Results: The program that paid agents the highest annual compensation (US$3 98) also had the highest costs per agent ($701), but it had the highest num ber of visits per agent (425). The program that had the lowest annual payme nts per agent ($33) also had high costs per agent ($553), because its other costs were high and ifs agents produced few visits (105). The simulations showed that an increase in the amount spent on agent remuneration reduces c osts per visit, because the number of agent visits increases, thereby sprea ding out supervision and training costs over a larger number of visits. Conclusions: The challenge for CBD programs seeking to reduce their costs i s to determine which cost components to decrease so as to minimize any redu ction in visits. For example, programs that spend little on compensation mi ght improve their performance by spending more on compensation but less on training or supervision.