What costs and what benefits.For the health sector, for the economy and For society?MRC Investment Case, June 2017
Community health workers (CHWs) are increasingly shown to have the potential to improve the health status of the population, in particular that of the more disadvantaged or those living in hard to reach areas. Their involvement in mother and child programmes, HIV/AIDs and TB programmes as well as chronic diseases and palliative care has been documented across many countries. Many studies have documented impressive impacts due to better prevention through health education, to significantly higher case-finding than in standard care, better support for treatment adherence and increased control or cure rate, to better support for palliative care allowing patients to remain with their families at the end of their lives. However, in many low income countries the CHW platform has been very patchy with inadequate training, inadequate support and supervision, uncertain funding and low morale amongst CHWs. This weak system then leads to underperformance and disappointing results.
In South Africa in 2012 the government launched the PHC re-engineering approach which placed the WBOTs system (Ward-based outreach teams) firmly in the continuum of PHC services with strong linkages with PHC facilities and district hospitals to improve access, detection and support in the community. The roll-out of WBOTs has been uneven and this platform is generally under-resourced. A new study on WBOTs in 2 provinces, with more developed WBOTs system, showed that expenditure on WBOTs represented under 4% of their respective PHC expenditures.
The purpose of this investment case commissioned by the National Department of Health is to assess the return on investment of a strong CHW platform in South Africa.
This report reflects the potential of a high performing CHW platform based on findings from South African or international literature. The first part focusses on the impact of CHWs on the health sector. It follows a life course model and focusses on mother and child health, HIV/AIDs, TB, Hypertension, Diabetes and Palliative care. It estimates deaths averted, DALYs averted, cost per additional DALY averted and whether the intervention is cost-effective or even cost-saving.
The second part of the report focusses on the benefits for the economy and society of the stronger CHW platform. It first looks at the multiplier effect of the CHW platform on increased employment, and at the impact on the economy of employing mainly poor women. It then estimates the productivity impact of improved health status of the population through CHWs interventions.
Finally the report presents the costing of an adequately resourced and supported CHW platform. It first presents absolute yearly costs, then the additional costs of this platform since some aspects of this platform already exist and are paid for.