Diana Bowser1, Adeyemi Okunogbe2, Elizabeth Oliveras3, Laura Subramanian4, Tyler Morrill5. 1. Brandeis University, Waltham, MA, USA dbowser@brandeis.edu. 2. RAND Corporation, Santa Monica, CA, USA. 3. Family Health International 360, Maputo, Mozambique. 4. Pathfinder International, Watertown, MA, USA. 5. Brandeis University, Waltham, MA, USA.
Abstract
INTRODUCTION: Community health worker (CHW) programs are a key strategy for reducing mortality and morbidity. Despite this, there is a gap in the literature on the cost and cost-effectiveness of CHW programs, especially in developing countries. METHODS: This study assessed the costs of a CHW program in Mozambique over the period 2010-2012. Incremental cost-effectiveness ratios, comparing the change in costs to the change in 3 output measures, as well as gains in efficiency were calculated over the periods 2010-2011 and 2010-2012. The results were reported both excluding and including salaries for CHWs. RESULTS: The results of the study showed total costs of the CHW program increased from US$1.34 million in 2010 to US$1.67 million in 2012. The highest incremental cost-effectiveness ratio was for the cost per beneficiary covered including CHW salaries, estimated at US$47.12 for 2010-2011. The smallest incremental cost-effectiveness ratio was for the cost per household visit not including CHW salaries, estimated at US$0.09 for 2010-2012. Adding CHW salaries would not only have increased total program costs by 362% in 2012 but also led to the largest efficiency gains in program implementation; a 56% gain in cost per output in the long run as compared with the short run after including CHW salaries. CONCLUSIONS: Our findings can be used to inform future CHW program policy both in Mozambique and in other countries, as well as provide a set of incremental cost per output measures to be used in benchmarking to other CHW costing analyses.
INTRODUCTION: Community health worker (CHW) programs are a key strategy for reducing mortality and morbidity. Despite this, there is a gap in the literature on the cost and cost-effectiveness of CHW programs, especially in developing countries. METHODS: This study assessed the costs of a CHW program in Mozambique over the period 2010-2012. Incremental cost-effectiveness ratios, comparing the change in costs to the change in 3 output measures, as well as gains in efficiency were calculated over the periods 2010-2011 and 2010-2012. The results were reported both excluding and including salaries for CHWs. RESULTS: The results of the study showed total costs of the CHW program increased from US$1.34 million in 2010 to US$1.67 million in 2012. The highest incremental cost-effectiveness ratio was for the cost per beneficiary covered including CHW salaries, estimated at US$47.12 for 2010-2011. The smallest incremental cost-effectiveness ratio was for the cost per household visit not including CHW salaries, estimated at US$0.09 for 2010-2012. Adding CHW salaries would not only have increased total program costs by 362% in 2012 but also led to the largest efficiency gains in program implementation; a 56% gain in cost per output in the long run as compared with the short run after including CHW salaries. CONCLUSIONS: Our findings can be used to inform future CHW program policy both in Mozambique and in other countries, as well as provide a set of incremental cost per output measures to be used in benchmarking to other CHW costing analyses.
Authors: Geoffrey Babughirana; Sanne Gerards; Alex Mokori; Isaac Charles Baigereza; Alex Mukembo; Grace Rukanda; Stef P J Kremers; Jessica Gubbels Journal: Int J Environ Res Public Health Date: 2021-04-21 Impact factor: 3.390
Authors: Manuel Romero-Hernández; Patricia Barber; Coraima Clavijo-Sánchez; Luis López-Rivero Journal: Int J Environ Res Public Health Date: 2021-02-02 Impact factor: 3.390