Evidence map›Paper›PMID 32838794›Full record

ArticleBMC public health2020

Evaluating the effect of village health workers on hospital admission rates and their economic impact in the Kingdom of Bhutan.

Sacha C Hauc, Dolley Tshering, Josemari Feliciano, Agata M P Atayde, Layla M Aboukhater, Kinley Dorjee, Tshering Dukpa, Pema Rinchen, Neema Yoezer, Casey M Luc and 3 more

Abstract read
In one paragraph

Article in BMC public health, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Sacha C HaucYale University School of Public Health, Laboratory of Epidemiology and Public Health, 60 College St, New Haven, CT, 06510, USA. sacha.hauc@yale.edu.ORCID http://orcid.org/0000-0002-6666-8578
Dolley TsheringBhutan Ministry of Health, Lhado Lam, Thimphu, Bhutan.
Josemari FelicianoYale University School of Public Health, Laboratory of Epidemiology and Public Health, 60 College St, New Haven, CT, 06510, USA.
Agata M P AtaydeBoston College, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA.
Layla M AboukhaterBoston College, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA.
Kinley DorjeeBhutan Ministry of Health, Lhado Lam, Thimphu, Bhutan.
Tshering DukpaKhesar Gyalpo University of Medical Sciences of Bhutan, Menkhang Lam, Thimphu, Bhutan.
Pema RinchenKhesar Gyalpo University of Medical Sciences of Bhutan, Menkhang Lam, Thimphu, Bhutan.
Neema YoezerKhesar Gyalpo University of Medical Sciences of Bhutan, Menkhang Lam, Thimphu, Bhutan.
Casey M LucYale University School of Public Health, Laboratory of Epidemiology and Public Health, 60 College St, New Haven, CT, 06510, USA.
Rup N AdhikariBhutan Ministry of Health, Lhado Lam, Thimphu, Bhutan.
Kezang LhamoBhutan Ministry of Health, Lhado Lam, Thimphu, Bhutan.
Kaveh KhoshnoodYale University School of Public Health, Laboratory of Epidemiology and Public Health, 60 College St, New Haven, CT, 06510, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundVillage health workers (VHWs) in Bhutan play an all-encompassing role in supporting the health of their communities. Recent reports from the Bhutan Ministry of Health have indicated a sharp reduction in the number of working VHWs. As such, our work attempts to estimate the cost saved and the number of averted hospital admissions onto the Bhutanese healthcare system and the individuals who are served by these health workers.

methodsWe utilized a dataset from the Bhutan Ministry of Health which encompassed over 95% of all reported disease cases within the nation. We examined the impact that VHWs have on hospital admission rates for eight diseases of interest by using multiple multivariate logistic regression models. Our model allowed us to estimate the potential disease cases averted when the average number of VHWs per health center is increased by one unit. Lastly, we utilized the 2011 "A Costing of Healthcare Services in Bhutan" to estimate the cost saved attributed to VHWs.

resultsAn average one unit increase of VHWs per health center is associated with a decrease in hospital and clinic admission for diarrhea, dysentery, wound care, depression/anxiety, dental caries, and skin infection, while a non-significant increase was observed for scabies and conjunctivitis. These findings translate to 4604 outpatient visits averted, with $28,637 saved, and 78 inpatient visits averted, with $10,711 saved. These values sum to a total of 4682 yearly averted admissions at health centers, with a total cost savings of $39,348 yearly. Additionally, we estimated a yearly savings of $13,348 in transportation costs and a total of $20,960 saved in wages to the community members that VHWs serve.

conclusionsVHWs serve as a source of cost-savings for the Kingdom of Bhutan and also act as an economic buffer for more vulnerable communities. The cost-savings associated with these health workers is likely to become more pertinent as the nation begins to develop and healthcare costs increase. It is imperative that proper action be taken to retain these health workers as every VHW who leaves the program increases healthcare costs onto the Bhutanese government.

Indexed as

Community Health WorkersBhutanCost SavingsHealth Care CostsHumansPatient AdmissionBhutanCommunity health workerHospital admissionsVillage health worker

Identifiers

PMID32838794
PMCPMC7445904

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.