title: A Cost-Effectiveness Analysis of Community Health Workers in Mozambique.
abstract: BACKGROUND
  Community health worker (CHW) programs are a key strategy for reducing mortality and morbidity. Despite this, there is a gap in the literature on the cost and cost-effectiveness of CHW programs, especially in developing countries.
  
  
  METHODS
  This study assessed the costs of a CHW program in Mozambique over the period 2010-2012. Incremental cost-effectiveness ratios, comparing the change in costs to the change in 3 output measures, as well as gains in efficiency were calculated over the periods 2010-2011 and 2010-2012. The results were reported both excluding and including salaries for CHWs.
  
  
  RESULTS
  The results of the study showed total costs of the CHW program increased from US$1.34 million in 2010 to US$1.67 million in 2012. The highest incremental cost-effectiveness ratio was for the cost per beneficiary covered including CHW salaries, estimated at US$47.12 for 2010-2011. The smallest incremental cost-effectiveness ratio was for the cost per household visit not including CHW salaries, estimated at US$0.09 for 2010-2012. Adding CHW salaries would not only have increased total program costs by 362% in 2012 but also led to the largest efficiency gains in program implementation; a 56% gain in cost per output in the long run as compared with the short run after including CHW salaries.
  
  
  CONCLUSIONS
  Our findings can be used to inform future CHW program policy both in Mozambique and in other countries, as well as provide a set of incremental cost per output measures to be used in benchmarking to other CHW costing analyses.
authors: Brandeis University, Waltham, MA, USA dbowser@brandeis.edu.
authors: Diana
authors: D
authors: Bowser
authors: RAND Corporation, Santa Monica, CA, USA.
authors: Adeyemi
authors: A
authors: Okunogbe
authors: Family Health International 360, Maputo, Mozambique.
authors: Elizabeth
authors: E
authors: Oliveras
authors: Pathfinder International, Watertown, MA, USA.
authors: Laura
authors: L
authors: Subramanian
authors: Brandeis University, Waltham, MA, USA.
authors: Tyler
authors: T
authors: Morrill
mesh_terms: D003150:Community Health Workers / Q000191:economics* / Q000458:organization & administration; D003362:Cost-Benefit Analysis; D017598:Efficiency, Organizational / Q000191:economics; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D009073:Mozambique; D012189:Retrospective Studies; D012456:Salaries and Fringe Benefits / Q000706:statistics & numerical data
keywords: access to care; community health; cost-effectiveness; efficiency; primary care