Abstract
BackgroundInterventions targeting community health workers (CHWs) aim to optimise the delivery of health services to underserved rural areas. Whilst interventions are evaluated against their objectives, there remains limited evidence on the economic costs of these interventions, and the practicality and value of scale up. The aim of this paper is to undertake a cost analysis on a CHW training and supervision intervention using exclusive breastfeeding rates amongst mothers as an outcome measure.MethodsThis is a retrospective cost analysis, from an implementer’s perspective, of a cluster randomised controlled trial investigating the effectiveness of a continuous quality improvement (CQI) intervention aimed at CHWs providing care and support to pregnant women and women with babies aged < 1 year in South Africa.ResultsOne of the outcomes of the RCT revealed that the prevalence of exclusive breastfeeding (EBF) significantly improved, with the cost per mother EBF in the control and intervention arm calculated at US$760,13 and US$1705,28 respectively. The cost per additional mother practicing EBF was calculated to be US$7647, 88, with the supervision component of the intervention constituting 64% of the trial costs. In addition, women served by the intervention CHWs were more likely to have received a CHW visit and had significantly better knowledge of childcare practices.ConclusionWhilst the cost of this intervention is high, adapted interventions could potentially offer an economical alternative for achieving selected maternal and child health (MCH) outcomes. The results of this study should inform future programmes aimed at providing adapted training and supervision to CHWs with the objective of improving community-level health outcomes.
Highlights
Interventions targeting community health workers (CHWs) aim to optimise the delivery of health services to underserved rural areas
Community health workers (CHWs) have the potential to address the barriers encountered by women and children in accessing maternal and child health (MCH) services, in underserved rural areas where the shortage of professional health workers is most profound [1]
CHWs can assist in bridging the gaps present in the delivery of integrated care at the health facility level [9] with several studies highlighting the potential role of CHWs in increasing access to health care for individuals living in underserved locations in South Africa [10, 11]
Summary
Interventions targeting community health workers (CHWs) aim to optimise the delivery of health services to underserved rural areas. Community health workers (CHWs) have the potential to address the barriers encountered by women and children in accessing maternal and child health (MCH) services, in underserved rural areas where the shortage of professional health workers is most profound [1]. The comparative advantage of utilising CHWs remains that they are from the community and are closer to the patient and their families and more accessible compared to facility based health personnel [7, 8]. CHWs can assist in bridging the gaps present in the delivery of integrated care at the health facility level [9] with several studies highlighting the potential role of CHWs in increasing access to health care for individuals living in underserved locations in South Africa [10, 11]
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