Abstract
BackgroundTanzania, like other African countries, faces significant health workforce shortages. With advisory and partnership from Columbia University, the Ifakara Health Institute and the Tanzanian Training Centre for International Health (TTCIH) developed and implemented the Connect Project as a randomized cluster experimental trial of the childhood survival impact of recruiting, training, and deploying of a new cadre of paid community health workers (CHW), named “Wawazesha wa afya ya Jamii” (WAJA). This paper presents an estimation of the cost of training and deploying WAJA in three rural districts of Tanzania.MethodsCosting data were collected by tracking project activity expenditure records and conducting in-depth interviews of TTCIH staff who have led the training and deployment of WAJA, as well as their counterparts at Public Clinical Training Centres who have responsibility for scaling up the WAJA training program. The trial is registered with the International Standard Randomized Controlled Trial Register number (ISRCTN96819844).ResultsThe Connect training cost was US$ 2,489.3 per WAJA, of which 40.1 % was for meals, 20.2 % for accommodation 10.2 % for tuition fees and the remaining 29.5 % for other costs including instruction and training facilities and field allowance. A comparable training program estimated unit cost for scaling-up this training via regional/district clinical training centres would be US$ 833.5 per WAJA. Of this unit cost, 50.3 % would involve the cost of meals, 27.4 % training fees, 13.7 % for field allowances, 9 % for accommodation and medical insurance. The annual running cost of WAJA in a village will cost US$ 1.16 per capita.ConclusionCosts estimated by this study are likely to be sustainable on a large scale, particularly if existing regional/district institutions are utilized for this program.
Highlights
IntroductionLike other African countries, faces significant health workforce shortages
Tanzania, like other African countries, faces significant health workforce shortages
There is a little doubt that this health workforce shortage has constituted a key barrier to achieving Millennium Development Goals (MDGs) 4 and 5 in Tanzania where 1 in 9 children die before the age of five [5, 10], maternal mortality is 432 per 100,000 live births [11, 12], and shortages of medicines and supplies, inadequate infrastructure and poor patient transportation systems amplify the effects of manpower shortage [13]
Summary
Like other African countries, faces significant health workforce shortages. Like many other African countries, is compelled to confront its high burden of disease with a low ratio of population density of health workers (HW) [1, 2]. A confluence of factors contribute to the manpower crisis: rapid population growth, health system resource constraints and inadequate worker training [4], emigration of health. In 2006, the World Health Organization (WHO) estimated that Africa had only 2.3 healthcare workers per 1,000 population compared with 4.3 for Southeast Asia and 24.8 for North. At 1.35 healthcare workers per 1,000 population and 1 physician per 25,000 population in 2010, Tanzania ranks below the average health professional population density for Africa [8, 9] and far below the WHO recommendation of 1 physician per 1,000 population. There is a little doubt that this health workforce shortage has constituted a key barrier to achieving MDGs 4 and 5 in Tanzania where 1 in 9 children die before the age of five [5, 10], maternal mortality is 432 per 100,000 live births [11, 12], and shortages of medicines and supplies, inadequate infrastructure and poor patient transportation systems amplify the effects of manpower shortage [13]
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