ArticleBMJ global health2017
Affordability of comprehensive community health worker programmes in rural sub-Saharan Africa.
Article in BMJ global health, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 2 of them syntheses that pooled it.
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Who cites it
25 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Barriers and facilitators of rendering HIV services by community health workers in sub-Saharan Africa: a meta-synthesis.Family medicine and community health · 2021Pooled it
- Pooled it
- Bringing malaria diagnosis and treatment closer to the people: economic rationale for expanding malaria community case management to all ages in a rural district in Madagascar.Malaria journal · 2025Trial
- Understanding what factors influence community health worker involvement in hypertension service delivery in Kenya: applying a community health system lens.Health policy and planning · 2026Article
- Costs and cost-effectiveness of integrated horizontal community health worker programmes in low- and middle-income countries (2015-2024): a scoping literature review.BMJ global health · 2025Article
- Optimising scale and deployment of community health workers in Sierra Leone: a geospatial analysis.BMJ global health · 2022Article
- Improving access to care and community health in Haiti with optimized community health worker placement.PLOS global public health · 2022Article
- Economic and cost-effectiveness analysis of the Community-Level Interventions for Pre-eclampsia (CLIP) trials in India, Pakistan and Mozambique.BMJ global health · 2021Article
- A review of prospective pathways and impacts of COVID-19 on the accessibility, safety, quality, and affordability of essential medicines and vaccines for universal health coverage in Africa.Globalization and health · 2021Review
- Mind the Global Community Health Funding Gap.Global health, science and practice · 2021Article
- Task-sharing with artificial intelligence: a design hypothesis for an Emergency Unit in sub-Saharan Africa.The Pan African medical journal · 2021Article
- Significant inefficiency in running community health systems: The case of health posts in Southwest Ethiopia.PloS one · 2021Article
- Barriers and facilitators of rendering HIV services by community health workers in sub-Saharan Africa: a meta-synthesis protocol.BMJ open · 2020Article
- Costing malaria interventions from pilots to elimination programmes.Malaria journal · 2020Article
- How do decision-makers use evidence in community health policy and financing decisions? A qualitative study and conceptual framework in four African countries.Health policy and planning · 2020Article
- Article
- Salaried and voluntary community health workers: exploring how incentives and expectation gaps influence motivation.Human resources for health · 2019Article
- Analysis of the quality of seasonal malaria chemoprevention provided by community health Workers in Boulsa health district, Burkina Faso.BMC health services research · 2019Article
- Valuing the Unpaid Contribution of Community Health Volunteers to Mass Drug Administration Programs.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2019Article
- Setting the global research agenda for community health systems: literature and consultative review.Human resources for health · 2019Review
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3 authors.
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Abstract
introductionCommunity health worker (CHW) programmes have low costs per person served and are central to achieving universal healthcare. However, their total cost is high and the target of one million CHWs for sub-Saharan Africa by 2015 was not met. We consider the affordability of rural CHW programmes by estimating total programme costs relative to national healthcare expenditure at different CHW salaries and resources available for healthcare.
methodsWe combine an existing source of rural CHW programme costs with World Bank data to estimate relative CHW programme costs in 37 countries. We consider three 'salaries' (CHWs as volunteers, paid the local equivalent of US$80 per month and paid the national minimum wage) and four potential healthcare budgets (both actual and Abuja declaration allocations alone and increased by external funding received and potential foreign aid, respectively). Costs are shown in 2012 nominal US$.
resultsWith CHWs paid the local equivalent of US$80 per month and financed from existing central government healthcare budgets, the median relative cost of a CHW programme would be 27% of the healthcare budget. While less than 2.5% in five countries (Botswana, Equatorial Guinea, Gabon, Namibia and South Africa), this relative cost would exceed 100% in three (Chad, Eritrea and Niger). There is a strong negative linear relationship (R
conclusionCHWs may be a stepping stone to universal access to professional healthcare, but there is high variability in the affordability of CHW programmes across sub-Saharan Africa. In many countries, such programmes are not yet affordable unless significant foreign aid is received.
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