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Category: Analysis

Description: Background: Globally, steps to revitalize programs deploying community health workers (CHWs) on a national scale have been growing, but few economic evaluations have been done on system-integrated CHW programs. Ghana has dual cadres of CHWs: community health officers (CHOs) and community health volunteers (CHVs). We activated CHVs in communities to mitigate the negative impact caused by CHO shortages. The CHVs conducted home visits and provided health education to prevent childhood diseases. We evaluated the cost-effectiveness and cost-benefit of activating CHVs. Methods: In a cluster-randomized trial with 40 communities in rural Ghana, the changes in disease incidence were inferred from a statistical model using a Bayesian generalized linear multilevel model, and disability-adjusted life years (DALYs) were estimated using a tree-based economic model. The time horizon was a 10-year period. Costs and DALYs were discounted at a rate of 3% per year. Results: According to the cost-effectiveness analysis, the program was highly likely to exceed the WHO-CHOICE threshold (1-3 times GDP per capita), but it was unlikely to exceed the conservative threshold (10-50% of GDP per capita). In the cost-benefit analysis, the mean and median benefit-cost ratios were 6.4 and 4.8, respectively. Conclusion: Since conservative thresholds are more appropriate for low- and middle-income countries, we interpreted the results as indicating that activating CHV’s home visits to prevent childhood diseases did not satisfy economic feasibility. To integrate CHW programs with national health systems, we need to find the most effective scope of work for CHWs.