Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Human Resources for Health
Published in: Human Resources for Health 1/2017

Open Access 01-12-2017 | Review

A systematic review of economic evaluations of CHW interventions aimed at improving child health outcomes

Authors: L. Nkonki, A. Tugendhaft, K. Hofman

Published in: Human Resources for Health | Issue 1/2017

Login to get access

Abstract

Evidence of the cost-effectiveness of community health worker interventions is pertinent for decision-makers and programme planners who are turning to community services in order to strengthen health systems in the context of the momentum generated by strategies to support universal health care, the post-2015 Sustainable Development Goal agenda.
We conducted a systematic review of published economic evaluation studies of community health worker interventions aimed at improving child health outcomes. Four public health and economic evaluation databases were searched for studies that met the inclusion criteria: National Health Service Economic Evaluation Database (NHS EED), Cochrane, Paediatric Economic Evaluation Database (PEED), and PubMed. The search strategy was tailored to each database.
The 19 studies that met the inclusion criteria were conducted in either high income countries (HIC), low- income countries (LIC) and/or middle-income countries (MIC). The economic evaluations covered a wide range of interventions. Studies were grouped together by intended outcome or objective of each study. The data varied in quality. We found evidence of cost-effectiveness of community health worker (CHW) interventions in reducing malaria and asthma, decreasing mortality of neonates and children, improving maternal health, increasing exclusive breastfeeding and improving malnutrition, and positively impacting physical health and psychomotor development amongst children.
Studies measured varied outcomes, due to the heterogeneous nature of studies included; a meta-analysis was not conducted. Outcomes included disease- or condition -specific outcomes, morbidity, mortality, and generic measures (e.g. disability-adjusted life years (DALYs)). Nonetheless, all 19 interventions were found to be either cost-effective or highly cost-effective at a threshold specific to their respective countries.
There is a growing body of economic evaluation literature on cost-effectiveness of CHW interventions. However, this is largely for small scale and vertical programmes. There is a need for economic evaluations of larger and integrated CHW programmes in order to achieve the post-2015 Sustainable Development Goal agenda so that appropriate resources can be allocated to this subset of human resources for health. This is the first systematic review to assess the cost-effectiveness of community health workers in delivering child health interventions.
Appendix
Available only for authorised users
Footnotes
1
CMAs in this type of economic evaluation comparisons of interventions are only based on costs, and outcomes are assumed to be identical. CMA seeks to answer the question, what is the least costly way to obtain an outcome?
 
2
CEA is of most use in situations where a decision marker, operating with a given budget, is considering a limited range of options within a given field. In a CEA, outcomes are measured in their natural units or life years saved.
 
3
CUA is a form of economic evaluation where the consequences of programmes are adjusted by health state preference scores or utility weights. In general terms, this means that one can assess the quality of life years gained, not just the crude number of years. The most common measure of consequences in CUAs is the quality-adjusted life year.
 
4
CBA is a form of economic evaluation that values consequences of programmes in money terms, so as to make them commensurate with the costs. This is the broadest form of analysis.
 
5
CC is a form of economic evaluation where decision-makers are presented with treatments or programmes with multiple objectives along with an array of the differential achievements, along each dimension, for the various alternatives. These data can then be presented to the decision-makers, so that they can make their own trade-off between effects.
 
6
A costing analysis is a partial economic evaluation.
 
7
Bangladesh, Thailand, Brazil, Haiti, Ethiopia, Mozambique, Pakistan, and South Africa.
 
Literature
1.
Gilson L, et al. National community health worker programs: how can they be strengthened? J Public Health Policy. 1989;10(4):518–32.CrossRefPubMed
2.
Ofosu-Amaah V. National experience in the use of community health workers: a review of current issues and problems. Geneva: World Health Organization; 1983.
3.
Bhattacharyya K, et al. Community health worker incentives and disincentives: how they affect motivation, retention, and sustainability. Virgian: Basics II; 2001.
4.
Lehmann U, Sanders D, Community Health Workers. What do we know about them? The state of the evidence on programmes, activities, costs and impact on health outcomes of using community health workers, Evidence and information for policy, department of human resource for health. Geneva: World Health Organisation; 2007.
5.
Bhutta ZA et al. Global experience of community health workers for delivery of health related Millennium Development Goals: a systematic review, country case studies, and recommendations for scaling up. Global health workforce alliance: health workers for all and all for health workers. 2010.
6.
Lewin S, et al. Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases (Review). The Cochrane Library. 2010. p. 211. Issue 3.
7.
Perry HB, Zulliger R, Rogers MM. Community health workers in low-, middle-, and high-income countries: an overview of their history, recent evolution, and current effectiveness. Annu Rev Public Health. 2014;35:399–421.CrossRefPubMed
8.
Lewin S et al. Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases. Cochrane Database Syst Rev. Update in progress.
9.
10.
Perry H, Zulliger R. How effective are community health workers? An overview of current evidence with recommendations for strengthening community health worker programs to accelerate progress in achieving the health-related Millennium Development Goals. Baltimore: John Hopkins Bloomberg School of Public Health; 2012.
11.
12.
Pegurri E, Fox-Rushby J, Damian W. The effects and costs of expanding the coverage of immunisation services in developing countries: a systematic literature review. Vaccine. 2005;23:1624–35.CrossRefPubMed
13.
Alonzo González M, Menendez C, Font F, Kahigwa E, Kimario J, Mshinda H, Tanner M, Bosch-Capblanch X, Alonso PL. Cost-effectiveness of iron supplementation and malaria chlorophyll in the prevention of anemia and malaria among Tanzanian infants. Bull World Health Organ. 2000;78(1):97–107.PubMedPubMedCentral
14.
Tozan Y, et al. Prereferral rectal artesunate for treatment of severe childhood malaria: a cost-effectiveness analysis. Lancet. 2010;376(9756):1910–5.CrossRefPubMed
15.
Conteh L, et al. Cost effectiveness of seasonal intermittent preventive treatment using amodiaquine & artesunate or sulphadoxine-pyrimethamine in Ghanaian children. PLoS One. 2010;5(8):e12223.CrossRefPubMedPubMedCentral
16.
Nonvignon J, et al. Is home management of fevers a cost-effective way of reducing under-five mortality in Africa? The case of a rural Ghanaian District La prise en charge à domicile des fièvres est-elle un moyen rentable de réduire la mortalité des enfants en Afrique? Cas d’un district rural du Ghana ¿El manejo domiciliario de la fiebre es una forma costo-efectiva de reducir la mortalidad en menores de cinco años en África? El caso de un distrito rural en Ghana. Trop Med Int Health. 2012;17(8):951–7.CrossRefPubMed
17.
18.
Pagnoni F, et al. A community-based programme to provide prompt and adequate treatment of presumptive malaria in children. Trans R Soc Trop Med Hyg. 1997;91(5):512–7.CrossRefPubMed
19.
20.
Barzgar MA, Sheikh MR, Bile MK. Female health workers boost primary care. World Health Forum. 1997;18(2):202–10.PubMed
21.
Gowani S, et al. Cost effectiveness of responsive stimulation and nutrition interventions on early child development outcomes in Pakistan. Ann N Y Acad Sci. 2014;1308(1):149–61.CrossRefPubMed
22.
Hafeez A, et al. Lady health workers programme in Pakistan: challenges, achievements and the way forward. J Pak Med Assoc. 2011;61(3):210–5.PubMed
23.
Borghi J, et al. Economic assessment of a women’s group intervention to improve birth outcomes in rural Nepal. Lancet. 2005;366(9500):1882–4.CrossRefPubMed
24.
Puett C, et al. Cost-effectiveness of the community-based management of severe acute malnutrition by community health workers in southern Bangladesh. Health Policy Plan. 2013;28(4):386–99.CrossRefPubMed
25.
San Sebastian M, et al. Improving immunization coverage in rural areas of Ecuador: a cost-effectiveness analysis. Trop Doct. 2001;31(1):21–4.CrossRefPubMed
26.
Aracena M, et al. A cost-effectiveness evaluation of a home visit program for adolescent mothers. J Health Psychol. 2009;14(7):878–87.CrossRefPubMed
27.
Melville B, et al. Growth monitoring: the role of community health volunteers. Public Health. 1995;109(2);111–6.CrossRefPubMed
28.
Frick KD, Pugh LC, Milligan RA. Costs related to promoting breastfeeding among urban low-income women. J Obstet Gynecol Neonatal Nurs. 2012;41(1):144–50.CrossRefPubMed
29.
Pugh LC, et al. Breastfeeding duration, costs, and benefits of a support program for low-income breastfeeding women. Birth. 2002;29(2):95–100.CrossRefPubMed
30.
Margellos-Anast H, Gutierrez MA, Whitman S. Improving asthma management among African-American children via a community health worker model: findings from a Chicago-based pilot intervention. J Asthma. 2012;49(4):380–9.CrossRefPubMed
31.
32.
Muenning P. Designing & conducting cost-effectiveness analyses in medicine & health care. 1st ed. 2002. p. 356.
33.
Morrell C, et al. Costs and benefits of community postnatal support workers: a randomised controlled trial. Health Technol Assess. 2000;4(6):86.
Metadata
Title
A systematic review of economic evaluations of CHW interventions aimed at improving child health outcomes
Authors
L. Nkonki
A. Tugendhaft
K. Hofman
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Human Resources for Health / Issue 1/2017
Electronic ISSN: 1478-4491
DOI
https://doi.org/10.1186/s12960-017-0192-5

Other articles of this Issue 1/2017

Human Resources for Health 1/2017 Go to the issue

Research

How female community health workers navigate work challenges and why there are still gaps in their performance: a look at female community health workers in maternal and child health in two Indian districts through a reciprocal determinism framework

Research

Long working hours in the healthcare system of the Belo Horizonte municipality, Brazil: a population-based cross-sectional survey

Research

The impact of a supportive supervision intervention on health workers in Niassa, Mozambique: a cluster-controlled trial

Research

Human Resource Information System implementation readiness in the Ethiopian health sector: a cross-sectional study

Research

Factors associated with occupancy of pharmacist positions in public sector hospitals in Uganda: a cross-sectional study

Research

Knowledge, attitudes, and values among physicians working with clinical genomics: a survey of medical oncologists