1.1 Purpose

Project RISE is a mixed-methods collaborative endeavor focused on improving the motivation and performance of Community Health Workers (CHWs) in Bihar, India. CHW programs consist of locally trained health professionals who serve the communities in which they live. Such programs are common in resource-limited and/or rural settings in much of the world and are often linked to improvements in health outcomes, but some also question if CHW programs are sufficiently impactful to warrant their expense.

Bihar is a state in India with relatively high maternal and infant mortality and India has the largest CHW program in the world, which makes Project RISE important in terms of: a) local impact - there is much to improve in Bihar; b) general impact - CHW programs are many and varied, but questions remain about how to determine the best ways to optimize CHW performance with respect to sustainable improvements in the quality and quantity of interactions and ensuring these interactions lead to significant improvements in health outcomes. Project RISE’s findings have potentially wide generality in this area.

Project RISE will formulate a behavioral intervention intended to assist CHWs in their work. A unique feature of RISE is the focus on community rituals and an embracing of the complexity that comes with an emphasis on lived experiences of CHWs and the many sources of influence in any cultural system. This orientation contrasts with much work on the topic of CHW performance, which often focuses on payments and incentive systems and how these systems affect performance on specific CHW duties. By harnessing ritual and focusing on the lived experiences of both CHWs and their beneficiaries, Project RISE formulates a unique and strong empirical and conceptual foundation to understand the drivers of motivation and efficacy.

In these introductory chapters we set the stage for Project RISE’s results by:

  1. Articulating the motivation, goals, and rationale of Project RISE
  2. Summarizing the approach taken to reach these goals and how and why Project RISE is unique compared to many attempts to understand and improve CHW performance

Please note that the Preface of this Report contains important information on the structure of Project RISE, how to read this Report, the project timeline, and some logistical details.