A Cost-Effectiveness Analysis of Community Health Workers in Mozambique. (October 2015)

• Record Type: Journal Article
• Authors: Bowser, Diana; Okunogbe, Adeyemi; Oliveras, Elizabeth; Subramanian, Laura; Morrill, Tyler
• Is Part Of: Journal of primary care & community health. Volume 6:Number 4(2015:Oct.)
• Page Start: 227
• Page End: 232
• Publication Date: 2015-10
• Subjects: cost-effectiveness -- community health -- efficiency -- primary care -- access to care; Primary health care -- Periodicals; Primary health care -- United States -- Periodicals; Community health services -- Periodicals; Community health services -- United States -- Periodicals; 362.12
• DOI: 10.1177/2150131915579653
• Languages: English
• ISSNs: 2150-1319

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.