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

Diana Frymus said: ‘Better data on CHWs would help demonstrate their impact and cost-effectiveness’. This is corroborated by one of the new papers in the open-access journal Human Resources for Health. Below is the citation and abstract. The paper points to a relative lack of evidence / data on the cost-effectiveness of CHWs in the situations where they are most deployed, with the exception of tuberculosis.

Diana again: ‘There are still many policy makers who are skeptical of the value of CHWs. If we can demonstrate their value, we can get CHWs added as a formal member of the health team, with proper support supervision, a career ladder, and a salary.’ Clearly, stronger evidence of their cost-effectiveness would greatly help to convince policymakers to invest more in CHW scale-up.

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

Kelsey Vaughan1*, Maryse C Kok1, Sophie Witter2 and Marjolein Dieleman1

* Corresponding author: Kelsey Vaughan

Human Resources for Health 2015, 13:71  doi:10.1186/s12960-015-0070-y

The electronic version of this article is the complete one and can be found online at:


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.

Best wishes, Neil

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