Costs and cost-effectiveness of community health workers: evidence from a literature review

Authors: Kelsey Vaughan, Maryse C Kok, Sophie Witter and Marjolein Dieleman

In recent years, community health workers (CHWs) have received renewed attention in light of critical shortages in the health workforce and emphasis on strengthening primary healthcare systems for achieving global health goals. CHWs are generally assumed to be a less expensive alternative compared with other cadres of health workers, notably with regard to salary and incentives as well as training costs. In parallel, more and more evidence has accumulated in recent years on the effectiveness of CHWs in delivery of essential health services in low- and middle-income countries (LMICs). However, studies assessing the costs and/or cost-effectiveness of CHW programmes are limited due both to data and methodological problems. Therefore, we conducted an exploratory literature review to:

1. provide an overview of what is globally known about CHWs’ costs and cost-effectiveness

2. identify methodologies and elements of costs, effects and cost-effectiveness included in and excluded from studies to date

3. discuss appropriate methodologies for evaluating the costs and cost-effectiveness of CHWs.

As this was an exploratory review, no estimates in monetary terms (dollar values) are presented. Nonetheless, the overall conclusions about the costs and cost-effectiveness of CHWs will serve to inform policy dialogue around the role of CHWs in health systems, and findings about methodologies will encourage researchers to properly assess the costs and cost-effectiveness of such programmes.