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Nepal P, Schwarz R, Citrin D, Thapa A, Acharya B, Acharya Y, Aryal A, Baum A, Bhandari V, Bhatt L, Bhattarai D, Choudhury N, Dangal B, Dhimal M, Dhungana SK, Gauchan B, Halliday S, Kalaunee SP, Kunwar LB, Maru D, Nirola I, Paudel R, Raut A, Rayamazi HJ, Sapkota S, Schwarz D, Thapa P, Thapa P, Tiwari A, Tuitui R, Walter E, Maru S. Costing Analysis of a Pilot Community Health Worker Program in Rural Nepal. GLOBAL HEALTH: SCIENCE AND PRACTICE 2020; 8:239-255. [PMID: 32606093 PMCID: PMC7326517 DOI: 10.9745/ghsp-d-19-00393] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 05/19/2020] [Indexed: 01/01/2023]
Abstract
Data from a retrospective costing analysis offers insights and practical considerations for policy makers and locally elected officials for designing and implementing a new community health work cadre as a mechanism to achieve SDG targets in Nepal. Community health workers (CHWs) are essential to primary health care systems and are a cost-effective strategy to achieve the Sustainable Development Goals (SDGs). Nepal is strongly committed to universal health coverage and the SDGs. In 2017, the Nepal Ministry of Health and Population partnered with the nongovernmental organization Nyaya Health Nepal to pilot a program aligned with the 2018 World Health Organization guidelines for CHWs. The program includes CHWs who: (1) receive regular financial compensation; (2) meet a minimum education level; (3) are well supervised; (4) are continuously trained; (5) are integrated into local primary health care systems; (6) use mobile health tools; (7) have consistent supply chain; (8) live in the communities they serve; and (9) provide service without point-of-care user fees. The pilot model has previously demonstrated improved institutional birth rate, antenatal care completion, and postpartum contraception utilization. Here, we performed a retrospective costing analysis from July 16, 2017 to July 15, 2018, in a catchment area population of 60,000. The average per capita annual cost is US$3.05 (range: US$1.94 to US$4.70 across 24 villages) of which 74% is personnel cost. Service delivery and administrative costs and per beneficiary costs for all services are also described. To address the current discourse among Nepali policy makers at the local and federal levels, we also present 3 alternative implementation scenarios that policy makers may consider. Given the Government of Nepal’s commitment to increase health care spending (US$51.00 per capita) to 7.0% of the 2030 gross domestic product, paired with recent health care systems decentralization leading to expanded fiscal space in municipalities, this CHW program provides a feasible opportunity to make progress toward achieving universal health coverage and the health-related SDGs. This costing analysis offers insights and practical considerations for policy makers and locally elected officials for deploying a CHW cadre as a mechanism to achieve the SDG targets.
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Affiliation(s)
| | - Ryan Schwarz
- Possible, New York, NY, USA. .,Brigham and Women's Hospital, Department of Medicine, Division of Global Health Equity, Boston, MA, USA.,Harvard Medical School, Department of Medicine, Boston, MA, USA.,Massachusetts General Hospital, Department of Medicine, Division of General Internal Medicine, Boston, MA, USA
| | - David Citrin
- Possible, New York, NY, USA.,University of Washington, Department of Global Health, Seattle, WA, USA.,University of Washington, Department of Anthropology, Seattle, WA, USA.,University of Washington, Henry M. Jackson School of International Studies, Seattle, WA, USA.,Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY, USA
| | | | - Bibhav Acharya
- Possible, New York, NY, USA.,University of California, San Francisco, Department of Psychiatry, San Francisco, CA, USA
| | - Yubraj Acharya
- Pennsylvania State University, College of Health and Human Development, Department of Health Policy and Administration, University Park, PA, USA
| | - Anu Aryal
- Nyaya Health Nepal, Kathmandu, Nepal
| | - Aaron Baum
- Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY, USA
| | | | | | | | - Nandini Choudhury
- Possible, New York, NY, USA.,Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY, USA
| | | | | | | | - Bikash Gauchan
- Nyaya Health Nepal, Kathmandu, Nepal.,University of California, San Francisco, Health Equity Action Leadership Initiative, San Francisco, CA, USA
| | - Scott Halliday
- Possible, New York, NY, USA.,University of Washington, Department of Global Health, Seattle, WA, USA.,University of Washington, Department of Anthropology, Seattle, WA, USA.,University of Washington, Henry M. Jackson School of International Studies, Seattle, WA, USA
| | - S P Kalaunee
- Nyaya Health Nepal, Kathmandu, Nepal.,Eastern University, College of Leadership and Development, St. Davids, PA, USA
| | | | - Duncan Maru
- Possible, New York, NY, USA.,Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY, USA.,Icahn School of Medicine at Mount Sinai, Department of Health Systems Design and Global Health, New York, NY, USA.,Icahn School of Medicine at Mount Sinai, Department of Internal Medicine, New York, NY, USA.,Icahn School of Medicine at Mount Sinai, Department of Pediatrics, New York, NY, USA
| | - Isha Nirola
- Possible, New York, NY, USA.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | | | | | | | - Dan Schwarz
- Possible, New York, NY, USA.,Brigham and Women's Hospital, Department of Medicine, Division of Global Health Equity, Boston, MA, USA.,Harvard Medical School, Department of Medicine, Boston, MA, USA.,Beth Israel Deaconess Medical Center, Department of Medicine, Boston, MA, USA.,Ariadne Labs, Harvard T.H. Chan School of Public Health and Brigham and Women's Hospital, Boston, MA, USA
| | - Poshan Thapa
- University of New South Wales, School of Public Health and Community Medicine, Sydney, NSW, Australia
| | | | | | - Roshani Tuitui
- Nursing and Social Security Division, Dept of Health Services, Kathmandu, Nepal
| | - Eric Walter
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.,University of Pennsylvania, The Wharton School, Healthcare Management Department, Philadelphia, PA, USA
| | - Sheela Maru
- Possible, New York, NY, USA.,Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY, USA.,Icahn School of Medicine at Mount Sinai, Department of Health Systems Design and Global Health, New York, NY, USA.,Icahn School of Medicine at Mount Sinai, Department of Obstetrics, Gynecology and Reproductive Science, New York, NY, USA
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