Multi-country analysis of the cost of community health workers kits and commodities for community-based maternal and newborn care

Diana Barger (), Helen Owen, Catherine Pitt, Kate Kerber, Deborah Sitrin, Chrispus Mayora, Tanya Guenther, Emmanuelle Daviaud and Joy Lawn
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Diana Barger: Save the Children
Helen Owen: LSHTM - London School of Hygiene and Tropical Medicine
Catherine Pitt: LSHTM - London School of Hygiene and Tropical Medicine
Kate Kerber: Save the Children
Deborah Sitrin: Save the Children
Chrispus Mayora: Makerere University School of Public Health
Tanya Guenther: Save the Children
Emmanuelle Daviaud: South African Medical Research Council, Health Systems Research Unit
Joy Lawn: LSHTM - London School of Hygiene and Tropical Medicine

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Abstract: Community-based maternal and newborn care with home visits by community health workers (CHWs) are recommended by WHO to complement facility-based care. As part of multi-country economic and systems analyses, we aimed to compare the content and financial costs associated with equipping CHWs or 'home visit kits' from seven studies in Bolivia, Ethiopia, Ghana, Malawi, South Africa, Tanzania and Uganda. We estimated the equivalent annual costs (EACs) of home visit kits per CHW in constant 2015 USD. We estimated EAC at scale in a population of 100 000 assuming four home visits per mother during the pregnancy and postnatal period. All seven packages were designed for health promotion; six included clinical assessments and one included curative care. The items used by CHWs differed between countries, even for the same task. The EAC per home visit kit ranged from $15 in Tanzania to $116 in South Africa. For health promotion and preventive care, between 82 and 100% of the cost of CHW commodities did not vary with the number of home visits conducted; however, in Ethiopia, the majority of EAC associated with curative care varied with the number of visits conducted. The EAC of equipping CHWs to meet the needs of 95% of expectant mothers in a catchment area of 100 000 people was highest in Bolivia, $40 260 for 633 CHWs, due to mothers being in hard-to-reach areas with CHW conducting few visits per year per, and lowest in Tanzania ($2693 for 172 CHWs), due to the greater number of CHW visits per week and lower EAC of items. To inform and ensure sustainable implementation at scale, national discussions regarding the cadre of CHWs and their workload should also consider carefully the composition and cost of equipping CHWs to carry out their work effectively and efficiently.

Keywords: Community health workers commodities home visit kits economic evaluation costing scale-up home-visits maternal and newborn; Community health workers; commodities; home visit kits; economic evaluation; costing; scale-up; home-visits; maternal and newborn (search for similar items in EconPapers)
Date: 2017-10-01
Note: View the original document on HAL open archive server: https://hal.science/hal-04888791v1
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Published in Health Policy and Planning, 2017, 32 (suppl_1), pp.i84-i92. ⟨10.1093/heapol/czx038⟩

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Persistent link: https://EconPapers.repec.org/RePEc:hal:journl:hal-04888791

DOI: 10.1093/heapol/czx038

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