A follow-up of 54 CMDs was performed in CCMm for a period of 12 months using time and motion study sheets  to document time spent on key activities of CCMm to estimate the value of work time of CMDs in CCMm. Volunteer CMDs work for 4.8 hours, about 60% of a standard work day of eight hours, yet the economic value of their effort has rarely been explored [12, 13]. The question is how much monetary reward in Ghana Cedis do CMDs earn from CCMm activities? Accurate estimates of the value of volunteer work may be useful to decide on appropriate incentives packages for CMDs.
CMDs had on average nine years’ experiences as volunteers. A majority had only basic education, which means that regular training should be part of an incentive package. All CMDs were adult, married and had children, which meant that economic pressure as bread winners may be a disincentive to volunteering in CCMm.
Although CMDs did not receive regular remuneration for their CCMm work, they enjoyed social capital [1, 11] which was not available in the formal sector. Direct benefits to volunteers were identified as self esteem (“village doctors”), increased skills, recognition, and packed lunch during training. They also benefitted from non-salary remuneration such as bicycles, torch lights, boots and raincoats and recognition at health facilities .
The CMDs’ economic activities were interrupted by CCMm activities. Compared with the incentive given in CCMm, the value of “normal” work time was four times higher. This was likely to affect their income flow and adversely affect the upkeep of their homes. In CCMm, CMDs were paid 6.4 times lower than their reported monthly income. The use of minimum wage underestimated the value of the work time of CMDs by GH¢1.9. This corroborates with similar findings by Asenso-Okyere and Dzator , when they estimated the household cost of seeking care in two districts in Ashanti region of Ghana, suggesting that the use of village wage rate may be preferred to estimating the time value of workers in health programmes.
There were limitations in the study. The study used reported monthly income of CMDs. This was difficult to validate as CMDs had no income records. Judging from the fact that CMDs had lower education level, the possibilities of errors in their records from which the value of time was estimated could not be ruled out. Also, social desirability bias may have influenced CMDs’ responses to the survey questions. The value of work time was estimated in terms of foregone monthly income (based on reported income of CMDs). This was difficult to validate in a subsistence economy where there is virtually no record on income. The study did not include the cost of community meetings as these were not available under the CCMm. It excluded work hours at weekends as rate of part-time work was not available. It is important to caution that in African society, especially Ghana, one is obliged to greet whoever he meets and this can sometimes lead to more than 10 minutes’ conversation. It is possible the CMD wrongly included these in time utilized.
The average follow-up was higher than the average number of children seen. This was possible as some children were visited more than once. These factors limit the generalizability of the results to some extent. Notwithstanding, the study makes a case for the institutionalization of the efforts of CMDs especially in areas described as “hard-to-reach” as means of recognizing their effort in health care delivery.