TY - JOUR T1 - Costing Analysis of a Pilot Community Health Worker Program in Rural Nepal JF - Global Health: Science and Practice JO - GLOB HEALTH SCI PRACT SP - 239 LP - 255 DO - 10.9745/GHSP-D-19-00393 VL - 8 IS - 2 AU - Prajwol Nepal AU - Ryan Schwarz AU - David Citrin AU - Aradhana Thapa AU - Bibhav Acharya AU - Yubraj Acharya AU - Anu Aryal AU - Aaron Baum AU - Ved Bhandari AU - Laxman Bhatt AU - Dipak Bhattarai AU - Nandini Choudhury AU - Binod Dangal AU - Meghnath Dhimal AU - Santosh Kumar Dhungana AU - Bikash Gauchan AU - Scott Halliday AU - SP Kalaunee AU - Lal Bahadur Kunwar AU - Duncan Maru AU - Isha Nirola AU - Rashmi Paudel AU - Anant Raut AU - Hari Jung Rayamazi AU - Sabitri Sapkota AU - Dan Schwarz AU - Poshan Thapa AU - Pratistha Thapa AU - Aparna Tiwari AU - Roshani Tuitui AU - Eric Walter AU - Sheela Maru Y1 - 2020/06/30 UR - http://www.ghspjournal.org/content/8/2/239.abstract N2 - Key FindingsThe average per capita annual cost of a pilot community health worker (CHW) program in rural Nepal is US$3.05.Personnel costs, the largest cost driver, contribute 74% of the total implementation costs and are affected by the number of households covered, population distribution, geographical terrain, and supervision structure.Key ImplicationsPolicy makers should consider further expansion and improvement of community health systems to make progress toward achieving universal health coverage and the health-related Sustainable Development Goals.Policy makers may benefit from considering alternative implementation scenarios that explore 3 challenges with CHWs: payment amount, supervision structure, and integration of new cadres into local primary health care systems.Community health workers (CHWs) are essential to primary health care systems and are a cost-effective strategy to achieve the Sustainable Development Goals (SDGs). Nepal is strongly committed to universal health coverage and the SDGs. In 2017, the Nepal Ministry of Health and Population partnered with the nongovernmental organization Nyaya Health Nepal to pilot a program aligned with the 2018 World Health Organization guidelines for CHWs. The program includes CHWs who: (1) receive regular financial compensation; (2) meet a minimum education level; (3) are well supervised; (4) are continuously trained; (5) are integrated into local primary health care systems; (6) use mobile health tools; (7) have consistent supply chain; (8) live in the communities they serve; and (9) provide service without point-of-care user fees. The pilot model has previously demonstrated improved institutional birth rate, antenatal care completion, and postpartum contraception utilization. Here, we performed a retrospective costing analysis from July 16, 2017 to July 15, 2018, in a catchment area population of 60,000. The average per capita annual cost is US$3.05 (range: US$1.94 to US$4.70 across 24 villages) of which 74% is personnel cost. Service delivery and administrative costs and per beneficiary costs for all services are also described. To address the current discourse among Nepali policy makers at the local and federal levels, we also present 3 alternative implementation scenarios that policy makers may consider. Given the Government of Nepal’s commitment to increase health care spending (US$51.00 per capita) to 7.0% of the 2030 gross domestic product, paired with recent health care systems decentralization leading to expanded fiscal space in municipalities, this CHW program provides a feasible opportunity to make progress toward achieving universal health coverage and the health-related SDGs. This costing analysis offers insights and practical considerations for policy makers and locally elected officials for deploying a CHW cadre as a mechanism to achieve the SDG targets. ER -