Article Text
Abstract
Introduction Community health worker (CHW) programmes have low costs per person served and are central to achieving universal healthcare. However, their total cost is high and the target of one million CHWs for sub-Saharan Africa by 2015 was not met. We consider the affordability of rural CHW programmes by estimating total programme costs relative to national healthcare expenditure at different CHW salaries and resources available for healthcare.
Methods We combine an existing source of rural CHW programme costs with World Bank data to estimate relative CHW programme costs in 37 countries. We consider three ‘salaries’ (CHWs as volunteers, paid the local equivalent of US$80 per month and paid the national minimum wage) and four potential healthcare budgets (both actual and Abuja declaration allocations alone and increased by external funding received and potential foreign aid, respectively). Costs are shown in 2012 nominal US$.
Results With CHWs paid the local equivalent of US$80 per month and financed from existing central government healthcare budgets, the median relative cost of a CHW programme would be 27% of the healthcare budget. While less than 2.5% in five countries (Botswana, Equatorial Guinea, Gabon, Namibia and South Africa), this relative cost would exceed 100% in three (Chad, Eritrea and Niger). There is a strong negative linear relationship (R2=0.83, p<0.001) between the natural logs of gross domestic product (GDP) per capita and affordability. In 23 countries with GDP per capita under US$1200, the cost of a CHW programme would exceed 12% of actual healthcare spending if CHWs were paid US$80 per month.
Conclusion CHWs may be a stepping stone to universal access to professional healthcare, but there is high variability in the affordability of CHW programmes across sub-Saharan Africa. In many countries, such programmes are not yet affordable unless significant foreign aid is received.
- affordability
- community health workers
- sub-Saharan Africa
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Footnotes
Handling editor Seye Abimbola
Contributors CT and RL conceived the study. CT collected and analysed the data and drafted the manuscript. FG and RL contributed to the interpretation of the results and provided critical comments on early drafts of the manuscript. All authors approved the final submitted version. CT is the guarantor.
Funding This work was supported by a Medical Research Council Public Health Intervention Development Grant (Reference MR/M008065/1). CT and RL are supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care West Midlands initiative.
Disclaimer This paper presents independent research and the views expressed are those of the author(s) and not necessarily those of the National Health Service, NIHR or the Department of Health.
Competing interests FG and RL have received funding for research with community health workers in South Africa from the Medical Research Council. CT has no other interests.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement This study uses publicly available data. The aggregated dataset from the different sources used in this study is available on Mendeley (DOI: 10.17632/b38my6n8r9.3).