Per diems in polio eradication: Perspectives from community health workers and officials

Nearly all global health initiatives give per diems to community health workers (CHWs) in poor countries for shortterm work on disease-specific programs.Weinterviewed CHWs, supervisors, and high-level officials (n = 95) in 6 study sites across sub-Saharan Africa and South Asia in early 2012 about the per diems given to them by the Global Polio Eradication Initiative. These per diems for CHWs ranged from $1.50 to $2.40 per day. International officials defended per diems for CHWs with an arrayof arguments,primarily that they were necessary to defray the expenses that workers incurred during campaigns. But high-level ministry of health officials inmany countries were concerned that even small per diems were unsustainable. By contrast, CHWs saw per diems as a wage; the very small size of this wage led many to describe per diems as unjust. Per diem polio work existed in the larger context of limited and mostly exploitative options for female labor. Taking the perspectives of CHWs seriously would shift the international conversation about per diems towardquestionsof labor rights and justice in global health pay structures.