Figures & Tables
Figures
- FIGURE 1
Updated Annual Total Costs of At-Scale Community Health Worker Program Resource Needs in Sub-Saharan Africa,a by Model US$Billions
Abbreviations: CHW, community health worker; FAH, Financing Alliance for Health.a Key driving factors of cost are rural versus rural and urban coverage (62% versus 100% of sub-Saharan Africa population) and higher cost per community health worker (11% difference).
- FIGURE 2
Cost Comparison of National Community Health Programs Across 9 Countriesa in Sub-Saharan Africa, GDP Per Capita, US$
Abbreviation: GDP, gross domestic product.a Countries X and Y are masked - awaiting formal government approval to share the data.
- FIGURE 3
Average Community Health Worker to Population Ratio in 9 Countries in Sub-Saharan Africa
a Excludes country Y in the average number; model only costed one cadre who play more of a supervisory role and that serve entire population but did not include volunteer CHWs because the program has not been costed. Costs are based on recurrent costs including commodities. Costs reflected are final year costs for the duration of the community health strategy (and hence final year of costing model). This assumes that at the final year, the program will be fully scaled, hence will have reached the steady state. Steady state costing values are adjusted to 2019 US$for comparison. Countries X and Y are masked - awaiting formal government approval to share the data.
- FIGURE 4
Community Health Annualized Program Costs Showing Salaries and Incentives as the Main Cost Drivers Across 9 Countries in Sub-Saharan Africaa,b
a Commodities and salaries/incentives were the main cost drivers accounting for between 50%–90% of costs. Countries X and Y are masked; awaiting formal government approval to share the data.b Key insights: overhead costs were relatively higher for countries with whole directorates; inclusion of mobile phones resulted in relatively higher costs; countries with longer training programs had relatively higher training costs.
- FIGURE 5
The Average Annual Cost per Capita Served Across 9 Countries in Sub-Saharan Africa, US$a
a The annual average cost per person served ranged from $1.50–$13.0. Excludes country Y in the average number; model only costed one cadre who play more of a supervisory role and that serve entire population but did not include volunteer CHWS because the program has not been costed; costs are based on recurrent costs including commodities; costs reflected are final year costs for the duration of the community health strategy (and hence final year of costing model). This assumes that at the final year, the program will be fully scaled, hence will have reached the steady state. Steady state costing values are adjusted to 2019 USDs for comparison. Countries X and Y are masked; awaiting formal government approval to share the data.
- FIGURE 6
Cost Efficiency of Community Health Programs With Scale in 9 Countries in Sub-Saharan Africaa
a As the number of people served increases, cost per person served decreases. South Africa is an outlier with both a higher population and higher cost structure for its community health program, which is based on high-cost ward-based outreach teams, a multidisciplinary platform integrated into primary care. Excluding South Africa, the trendline goes downward indicating economies of scale likely due to shared fixed costs.
- FIGURE 7
Health Impact of the Community Health Worker Program in Rwanda
- FIGURE 8
The 8 Design Principles to Design Optimized Community Programs
- FIGURE 9
Correlation Between Country Income Status and Health Spending, Across 9 Countries in sub-Saharan Africa, Gross Domestic Product Per Capita, US$
Tables
Channel 1: Ministry of Finance Channel 2: Ministry of Health Channel 3: Outside of GOE Oversight Description Flows via Ministry of Finance. Includes unearmarked general budget support from donors (PBS) and GOE, and program-specific funds from some donors Flows via Ministry of Health. Includes pooled donor funds (M/SDG fund) and program-specific funds from some donors Flows from donors via implementing partners, largely outside of GOE oversight (but aligned with government strategies) % of total health fundinga 50% (includes Government of Ethiopia and donor budget support funds) 25% 25% Key mechanisms PBS: Pooled donor fund launched in 2006 to provide general budget support for basic services (across sectors) via federal block grants. ∼20% of PBS at woreda level used in health, largely for HEW salaries, and some for procurement M/SDGPF: Non-earmarked pooled donor fund for health sector support, launched in 2008. Scope of activities determined through consultative process and joint financing agreement each year. Funds supplies, training, construction (not salaries). Became SDGPF in 2015. Major donor contributors PBS: CIDA, Italy, Netherlands, World Bank
Other Channel 1: Austria, Spain, Irish Aid, UNICEF, UNFPA, WHO
M/SDGPF: DFID, Irish Aid, Italy, Spain, Netherlands, Gavi, UNFPA, WHO, World Bank
Other Channel 2: UNDP, CIDA, Italy, USAID, World Bank, Global Fund
USAID, PEPFAR, CDC (largest)
Most other bilateral and some multilateral donors provide some funds through channel 3
Abbreviations: CDC, U.S. Centers for Disease Control and Prevention; CIDA; Canadian International Development Agency; DFID, United Kingdom Department for International Development; GOE, Government of Ethiopia; M/SGDPF, Millennium/Sustainable Development Goal Performance Fund; PBS, Promoting Basic Services Program; PEPFAR, U.S. President's Emergency Plan for AIDS Relief; UNDP, United Nations Development Programme; UNFPA, United Nations Population Fund; UNICEF, United Nations Children's Fund; USAID, U.S. Agency for International Development; WHO, World Health Organization.
a Approximated based on Harvard/Ministry of Health data (2010).14 Estimates of % of funding through each channel are order of magnitude based on Harvard/Ministry of Health data from 2010. Indicative, not comprehensive.
