RT Journal Article
SR Electronic
T1 Costing Analysis of a Pilot Community Health Worker Program in Rural Nepal
JF Global Health: Science and Practice
JO GLOB HEALTH SCI PRACT
FD Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs
SP 239
OP 255
DO 10.9745/GHSP-D-19-00393
VO 8
IS 2
A1 Prajwol Nepal
A1 Ryan Schwarz
A1 David Citrin
A1 Aradhana Thapa
A1 Bibhav Acharya
A1 Yubraj Acharya
A1 Anu Aryal
A1 Aaron Baum
A1 Ved Bhandari
A1 Laxman Bhatt
A1 Dipak Bhattarai
A1 Nandini Choudhury
A1 Binod Dangal
A1 Meghnath Dhimal
A1 Santosh Kumar Dhungana
A1 Bikash Gauchan
A1 Scott Halliday
A1 SP Kalaunee
A1 Lal Bahadur Kunwar
A1 Duncan Maru
A1 Isha Nirola
A1 Rashmi Paudel
A1 Anant Raut
A1 Hari Jung Rayamazi
A1 Sabitri Sapkota
A1 Dan Schwarz
A1 Poshan Thapa
A1 Pratistha Thapa
A1 Aparna Tiwari
A1 Roshani Tuitui
A1 Eric Walter
A1 Sheela Maru
YR 2020
UL http://www.ghspjournal.org/content/8/2/239.abstract
AB 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.