WHO Bulletin: Maximizing the impact of community-based practitioners in the quest for universal health coverage

CITATION: Maximizing the impact of community-based practitioners in the quest for universal health coverage

James Campbell, Kesetebirhan Admasu, Agnes Soucat & Sheila Tlou.

Correspondence to James Campbell (email: campbellj@who.int).

Bulletin of the World Health Organization 2015;93:590-590A. doi: http://dx.doi.org/10.2471/BLT.15.162198

EXTRACTS (selected by Neil PW)

‘McPake et al. report that investment in these types of health workers can be a cost-effective approach, in certain contexts and under certain circumstances…’

‘The terms “frontline health workers” and “community health workers” are often used in a non-specific way and can confuse the evidence base. The term “frontline” is not a classification recognized by the World Health Organization (WHO) or the International Labour Organization (ILO). Even the official classification of community health workers can refer to a diverse typology of lay and educated, formal and informal, regulated and unregulated, paid and unpaid health workers. Different policies relating to individual cadres, their scope of practice, education and relation to the health system undermine efforts to strengthen service delivery at community level…’

‘WHO’s Global strategy on human resources for health: workforce 2030… recognizes the potential of involving community-based, mid-level and advanced practitioners as part of a multi-disciplinary health workforce that offers people-centred, integrated primary health services.’

‘Guidelines on the role, education and integration of community-based practitioners are being prepared by WHO for publication in 2017. These guidelines will provide governments and development partners with evidence-based recommendations on community-based practitioners, including potential returns on investment. These guidelines are intended to support universal health coverage and the achievement of the Sustainable Development Goals.’

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org


WHO Bulletin: Cost–effectiveness of community-based practitioner programmes in Ethiopia, Indonesia and Kenya

Please find below the citation and abstract of a paper in the September 2015 issue of the WHO Bulletin. Full text is freely available here: http://www.who.int/bulletin/volumes/93/9/14-144899/en/

CITATION: Cost-effectivenesss of community-based practitioner programmes in Ethiopia, Indonesia and Kenya

Barbara McPake, Ijeoma Edoka, Sophie Witter, Karina Kielmann, Miriam Taegtmeyer, Marjolein Dieleman, Kelsey Vaughan, Elvis Gama, Maryse Kok, Daniel Datiko, Lillian Otiso, Rukhsana Ahmed, Neil Squires, Chutima Suraratdecha & Giorgio Cometto

doi: 10.2471/BLT.14.144899

Cost–effectiveness of community-based practitioner programmes in Ethiopia, Indonesia and Kenya

Barbara McPake, Ijeoma Edoka, Sophie Witter, Karina Kielmann, Miriam Taegtmeyer, Marjolein Dieleman, Kelsey Vaughan, Elvis Gama, Maryse Kok, Daniel Datiko, Lillian Otiso, Rukhsana Ahmed, Neil Squires, Chutima Suraratdecha & Giorgio Cometto

Objective: To assess the cost–effectiveness of community-based practitioner programmes in Ethiopia, Indonesia and Kenya.

Methods: Incremental cost–effectiveness ratios for the three programmes were estimated from a government perspective. Cost data were collected for 2012. Life years gained were estimated based on coverage of reproductive, maternal, neonatal and child health services. For Ethiopia and Kenya, estimates of coverage before and after the implementation of the programme were obtained from empirical studies. For Indonesia, coverage of health service interventions was estimated from routine data. We used the Lives Saved Tool to estimate the number of lives saved from changes in reproductive, maternal, neonatal and child health-service coverage. Gross domestic product per capita was used as the reference willingness-to-pay threshold value.

Findings: The estimated incremental cost per life year gained was 82 international dollars ($)in Kenya, $999 in Ethiopia and $3396 in Indonesia. The results were most sensitive to uncertainty in the estimates of life-years gained. Based on the results of probabilistic sensitivity analysis, there was greater than 80% certainty that each programme was cost-effective.

Conclusion: Community-based approaches are likely to be cost-effective for delivery of some essential health interventions where community-based practitioners operate within an integrated team supported by the health system. Community-based practitioners may be most appropriate in rural poor communities that have limited access to more qualified health professionals. Further research is required to understand which programmatic design features are critical to effectiveness.

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org

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