Costs and cost-effectiveness of community health workers: evidence from a literature review

Hum Resour Health. 2015 Sep 1;13:71. doi: 10.1186/s12960-015-0070-y.


Objective: This study sought to synthesize and critically review evidence on costs and cost-effectiveness of community health worker (CHW) programmes in low- and middle-income countries (LMICs) to inform policy dialogue around their role in health systems.

Methods: From a larger systematic review on effectiveness and factors influencing performance of close-to-community providers, complemented by a supplementary search in PubMed, we did an exploratory review of a subset of papers (32 published primary studies and 4 reviews from the period January 2003-July 2015) about the costs and cost-effectiveness of CHWs. Studies were assessed using a data extraction matrix including methodological approach and findings.

Results: Existing evidence suggests that, compared with standard care, using CHWs in health programmes can be a cost-effective intervention in LMICs, particularly for tuberculosis, but also - although evidence is weaker - in other areas such as reproductive, maternal, newborn and child health (RMNCH) and malaria.

Conclusion: Notwithstanding important caveats about the heterogeneity of the studies and their methodological limitations, findings reinforce the hypothesis that CHWs may represent, in some settings, a cost-effective approach for the delivery of essential health services. The less conclusive evidence about the cost-effectiveness of CHWs in other areas may reflect that these areas have been evaluated less (and less rigorously) than others, rather than an actual difference in cost-effectiveness in the various service delivery areas or interventions. Methodologically, areas for further development include how to properly assess costs from a societal perspective rather than just through the lens of the cost to government and accounting for non-tangible costs and non-health benefits commonly associated with CHWs.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Clinical Competence
  • Communicable Disease Control / organization & administration
  • Community Health Workers / economics
  • Community Health Workers / organization & administration*
  • Community Health Workers / standards
  • Cost-Benefit Analysis
  • Developing Countries*
  • Health Services Administration / economics*
  • Health Services Administration / standards*
  • Humans
  • Malaria / diagnosis
  • Malaria / drug therapy
  • Maternal-Child Health Services / organization & administration
  • Outcome Assessment, Health Care
  • Policy
  • Quality of Health Care
  • Reproductive Health Services / organization & administration
  • Tuberculosis / diagnosis
  • Tuberculosis / drug therapy