Global Health Action (Dec 2023)

Trial-based economic evaluation of the system-integrated activation of community health volunteers in rural Ghana

  • Yinseo Cho,
  • Koku Awoonor-Williams,
  • Damin Jun,
  • Chunghyeon Oh,
  • Seungman Cha

DOI
https://doi.org/10.1080/16549716.2023.2203541
Journal volume & issue
Vol. 16, no. 1

Abstract

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Background Globally, steps to revitalise programmes deploying community health workers (CHWs) on a national scale have been growing, but few economic evaluations have been done on system-integrated CHW programmes. Ghana has dual cadres of CHWs: community health officers (CHOs) and community health volunteers (CHVs). CHO plays a major role in primary health services but has suffered from chronic staff shortages. We activated CHVs in communities to mitigate the negative impact due to CHO shortages. The CHVs conducted home visits and provided health education to prevent childhood diseases. Objective We evaluated the cost-effectiveness and cost-benefit of activating CHVs. Methods In a cluster-randomised trial with 40 communities in rural Ghana, the changes in disease incidence were inferred from a statistical model using a Bayesian generalised linear multilevel model. We evaluated the total incremental cost, benefit, and effectiveness for the intervention from an economic model. In cost-effectiveness analysis, disability-adjusted life years (DALYs) were estimated using a decision tree model. In the cost-benefit analysis, the cost-benefit ratio and net present value of benefit were estimated using a decision tree model, and a standardised sensitivity analysis was conducted. The decision tree model was a one-year cycle and run over 10-years. Costs, benefits, and effectiveness were discounted at a rate of 3% per year. Results According to the cost-effectiveness analysis, the programme was highly likely to exceed the WHO-CHOICE threshold (1–3 times GDP per capita), but it was unlikely to exceed the conservative threshold (10–50% of GDP per capita). In the cost-benefit analysis, the mean and median cost-benefit ratios were 6.4 and 4.8, respectively. Conclusion We found the potential economic strengths in the cost-benefit analysis. To integrate CHW programmes with national health systems, we need more research to find the most effective scope of work for CHWs.

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