Costs and cost-effectiveness of community health worker programs on reproductive, maternal, newborn and child health in low- and middle-income countries (2015–2024): A scoping review

Abstract

Community Health Workers (CHWs) are vital in delivering primary health care in low- and middle-income countries (LMICs). To inform their broader rollout, this study updates a 2015 review, critically examining the costs, cost-effectiveness and affordability of reproductive, maternal, newborn and child health (RMNCH) CHW programs in LMICs. A scoping review was conducted using ten databases and grey literature, covering studies published between August 2015 and July 2024. Search terms related to "Community Health Workers" and "Economic Evaluations" were used. Studies were screened via Covidence software based on inclusion and exclusion criteria. Data on study methodology, costs, and outcomes were extracted, tabulated in Microsoft Excel, and analysed. Across 53 studies (21 about reproductive health, maternal and newborn care and 32 child health focused), covering 161 scenarios, the most common cost metrics for CHW-led interventions were cost per beneficiary (ranging from $0.02 to $1,547), cost per capita (ranging from $0.09 to $20.25), and cost per consultation (ranging from $0.26 to $52.91). Of 100 scenarios that assessed cost-effectiveness, the majority concluded CHWs were cost-effective, most frequently when compared against an alternative service or delivery modality, such as facility-based care, or the no-longer widely accepted threshold of a country's gross domestic product per capita. Few studies assessed the affordability of CHW programs for government and/or partners. Evidence suggests that CHWs are often more cost-effective than alternative service or delivery modalities, particularly for child health. The evidence is however constrained by the heterogeneity of methods and reporting standards. To best guide future implementation of CHW programs, future research should focus on whether these interventions are affordable to governments and/or partners.