This study seeks to synthesize and critically review evidence on economic evaluations of Community Health Worker (CHW) programmes in low- and middle-income countries (LMICs) between 2015 and 2023. The last review published on this topic was in 2015. The aims of the study are (i) to provide an overview of the peer-reviewed and gray literature exploring the economic evaluation of CHW programmes based in LMICs between 2015-2023; (ii) to identify the demographics, methods and outcomes of these studies; (iii) to identify current gaps in the existing literature to inform original research addressing economic evaluation of CHW programmes and (iv) to specifically inform the design of an original economic evaluation of professional CHW programmes
This study seeks to synthesize and critically review evidence on economic evaluations of Community Health Worker (CHW) programmes in low- and middle-income countries (LMICs) between 2015 and 2023. The last review published on this topic was in 2015. The aims of the study are (i) to provide an overview of the peer-reviewed and gray literature exploring the economic evaluation of CHW programmes based in LMICs between 2015-2023; (ii) to identify the demographics, methods and outcomes of these studies; (iii) to identify current gaps in the existing literature to inform original research addressing economic evaluation of CHW programmes and (iv) to specifically inform the design of an original economic evaluation of professional CHW programmes
Sophie Witter - ORCID: 0000-0002-7656-6188
https://orcid.org/0000-0002-7656-6188Background Community health workers (CHWs) play a vital role in delivering primary health care in low- and middle-income countries (LMICs), addressing multiple diseases through horizontal programmes. Despite their effectiveness, there is a US4.4billionannualfundinggapforprofessionalCHWprogrammes.Somecountrieshaveadoptedtheseprogrammes,whileothersrequirestrongereconomicevidencetojustifyinvestments.Thisstudyupdatesa2015review,criticallyexaminingthecostsandcost−effectivenessofhorizontalCHWprogrammesinLMICs.MethodsAscopingreviewwasconductedusing10databasesandgreyliterature,coveringstudiespublishedbetweenAugust2015andJuly2024.Searchtermsrelatedto‘CommunityHealthWorkers’and‘EconomicEvaluations’wereused.StudieswerescreenedviaCovidencesoftwarebasedoninclusionandexclusioncriteria.Dataonstudymethodology,costandoutcomeswereextracted,tabulatedinMicrosoftExcelandanalysed.ResultsAtotalof18studies,covering42scenarios,wereincluded.Moststudiesfocusedonpartialeconomicevaluations,withcostanalysesbeingthemostcommonmethod.CHWcompensationvariedwidely,withamedianmonthlysalaryofUS265 (range US3033(148 (Ethiopia)–3181(Malawi));IQRUS346 (US203–US549)). The most commonly reported cost metric was the annual cost per capita, with a median of 6.02(range:0.29–$67.95). Sensitivity analyses were conducted in 29% of the scenarios, with six scenarios concluding CHW programmes were cost-effective. However, most did not conclude on cost-effectiveness or affordability, highlighting gaps in the evidence base. Service provision was the most frequently reported outcome, while cost per outcome and affordability were under-reported.
Conclusions This review highlights gaps in the economic evaluation of horizontal CHW programmes, particularly in cost-effectiveness and affordability. More large-scale evaluations are needed to inform national health policies and support sustained investment in CHW programmes to strengthen health systems and address workforce shortages.https://doi.org/10.1136/bmjgh-2024-01785210pubpub
Background Community health workers (CHWs) play a vital role in delivering primary health care in low- and middle-income countries (LMICs), addressing multiple diseases through horizontal programmes. Despite their effectiveness, there is a US4.4billionannualfundinggapforprofessionalCHWprogrammes.Somecountrieshaveadoptedtheseprogrammes,whileothersrequirestrongereconomicevidencetojustifyinvestments.Thisstudyupdatesa2015review,criticallyexaminingthecostsandcost−effectivenessofhorizontalCHWprogrammesinLMICs. MethodsAscopingreviewwasconductedusing10databasesandgreyliterature,coveringstudiespublishedbetweenAugust2015andJuly2024.SearchtermsrelatedtoCommunityHealthWorkers′andEconomicEvaluations′wereused.StudieswerescreenedviaCovidencesoftwarebasedoninclusionandexclusioncriteria.Dataonstudymethodology,costandoutcomeswereextracted,tabulatedinMicrosoftExcelandanalysed. ResultsAtotalof18studies,covering42scenarios,wereincluded.Moststudiesfocusedonpartialeconomicevaluations,withcostanalysesbeingthemostcommonmethod.CHWcompensationvariedwidely,withamedianmonthlysalaryofUS265 (range US3033(148 (Ethiopia)-3181(Malawi));IQRUS346 (US203−US549)). The most commonly reported cost metric was the annual cost per capita, with a median of 6.02(range:0.29-$67.95). Sensitivity analyses were conducted in 29% of the scenarios, with six scenarios concluding CHW programmes were cost-effective. However, most did not conclude on cost-effectiveness or affordability, highlighting gaps in the evidence base. Service provision was the most frequently reported outcome, while cost per outcome and affordability were under-reported. Conclusions This review highlights gaps in the economic evaluation of horizontal CHW programmes, particularly in cost-effectiveness and affordability. More large-scale evaluations are needed to inform national health policies and support sustained investment in CHW programmes to strengthen health systems and address workforce shortages.</p
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