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Affordability of comprehensive community health worker programmes in rural sub-Saharan Africa
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Taylor, Celia A., Griffiths, Frances and Lilford, Richard (2017) Affordability of comprehensive community health worker programmes in rural sub-Saharan Africa. BMJ Global Health, 2 (3). e000391. doi:10.1136/bmjgh-2017-000391 ISSN 2059-7908.
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Official URL: http://dx.doi.org/10.1136/bmjgh-2017-000391
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.
| Item Type: | Journal Article | |||||||||
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| Subjects: | R Medicine > RA Public aspects of medicine | |||||||||
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Community health aides -- Cost effectiveness -- Africa, Volunteer workers in community health services -- Africa, Rural health -- Africa, Medical care -- Africa, Medical personnel -- Africa, World Bank -- Statistics -- Africa, Medical economics -- Africa | |||||||||
| Journal or Publication Title: | BMJ Global Health | |||||||||
| Publisher: | BMJ | |||||||||
| ISSN: | 2059-7908 | |||||||||
| Official Date: | 2017 | |||||||||
| Dates: |
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| Volume: | 2 | |||||||||
| Number: | 3 | |||||||||
| Article Number: | e000391 | |||||||||
| DOI: | 10.1136/bmjgh-2017-000391 | |||||||||
| Status: | Peer Reviewed | |||||||||
| Publication Status: | Published | |||||||||
| Date of first compliant deposit: | 29 September 2017 | |||||||||
| Date of first compliant Open Access: | 29 September 2017 | |||||||||
| RIOXX Funder/Project Grant: |
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