RT Journal Article
SR Electronic
T1 Community Health Worker Program Sustainability in Africa: Evidence From Costing, Financing, and Geospatial Analyses in Mali
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 S79
OP S97
DO 10.9745/GHSP-D-20-00404
VO 9
IS Supplement 1
A1 Pascal Saint-Firmin, Patrick
A1 Diakite, Birama
A1 Ward, Kevin
A1 Benard, Mitto
A1 Stratton, Sara
A1 Ortiz, Christine
A1 Dutta, Arin
A1 Traore, Seydou
YR 2021
UL http://www.ghspjournal.org/content/9/Supplement_1/S79.abstract
AB Key FindingsIn 2015, cost-saving opportunities of US$6.16 million were identified in 41 of 44 districts.Costs required for community health worker (CHW) programs can be reduced without sacrificing quality and spending can be geographically targeted to optimize service use by rural populations.Key ImplicationsProgram managers and stakeholders should use geospatial analyses to reflect critically on CHW resource planning and make evidence easier to act upon.Key decision makers should assess what efficiency gains in funding can be achieved with geospatial targeting and mapping.Background:In Mali, community health workers (CHWs) deliver essential community care (ECC) to rural populations. The dominance of external funding for the program threatens the sustainability of this critical workforce as donor financing decreases. This article summarizes results of analyses aimed at assisting Mali's decision makers and leaders in initiating a transition to a sustainable CHW program supported by domestic funding through strategic and rational investment.Methods:Data on ECC implementation norms, workforce, coverage, utilization, cost, and geospatial features were collected between 2016 and 2019. The data informed interlinked CHW financing analyses—situational, services costing, efficiency, and geospatial mapping. Analysis showed distribution of reported expenditures, estimates of required CHW funding, cost-saving options, and spatially visualized discrepancies between spending estimates and normative costs.Results:Thirteen financing sources contributed to CHW program expenditures, 88% of which were from international donors, for a package of 23 curative, preventive, and promotive interventions. In 2015, the CHW program spent US$13.01 million; an estimated US$8.36 million would have been needed to achieve the same service volume under standard care protocols. Medicines and start-up training had US$6.88 million more than needed; supervision, program management, and recurrent training components were underfunded by US$2.2 million. Cost-saving opportunities of US$6.16 million were identified in 41 of 44 districts. Funding reallocation opportunities (after meeting technical efficiency requirements) were identified in 20 of 44 districts (US$2.56 million). Use of geospatial targeting and mapping suggests district- and village-level reallocation options for theoretical funding surpluses.Conclusion:CHW costs can be significantly reduced without sacrificing service technical quality. Spending can be geographically targeted to optimize service use by rural populations. Efficiency analyses provide evidence to build stronger engagement, support improved decision making, efficiently prioritize resources, and target investments for sustainable financing of CHW programs.