Costing Analysis of a Pilot Community Health Worker Program in Rural Nepal

被引：12

作者：

Nepal, Prajwol ^{[1
]}

Schwarz, Ryan ^{[1
,2
,3
,4
]}

Citrin, David ^{[1
,5
,6
,7
,8
]}

Thapa, Aradhana ^{[9
]}

Acharya, Bibhav ^{[1
,10
]}

Acharya, Yubraj ^{[11
]}

Aryal, Anu ^{[9
]}

Baum, Aaron ^{[8
]}

Bhandari, Ved ^{[9
]}

Bhatt, Laxman ^{[9
]}

Bhattarai, Dipak ^{[9
]}

Choudhury, Nandini ^{[1
,8
]}

Dangal, Binod ^{[9
]}

Dhimal, Meghnath ^{[12
]}

Dhungana, Santosh Kumar ^{[9
]}

Gauchan, Bikash ^{[9
,13
]}

Halliday, Scott ^{[1
,5
,6
,7
]}

Kalaunee, S. P. ^{[9
,14
]}

Kunwar, Lal Bahadur ^{[9
]}

Maru, Duncan ^{[1
,8
,15
,16
,17
]}

Nirola, Isha ^{[1
,18
]}

Paudel, Rashmi ^{[9
]}

Raut, Anant ^{[1
]}

Rayamazi, Hari Jung ^{[9
]}

Sapkota, Sabitri ^{[9
]}

Schwarz, Dan ^{[1
,2
,3
,19
,20
,21
]}

Thapa, Poshan ^{[22
]}

Thapa, Pratistha ^{[9
]}

Tiwari, Aparna ^{[9
]}

Tuitui, Roshani ^{[23
]}

Walter, Eric ^{[24
,25
]}

Maru, Sheela ^{[1
,8
,15
,26
]}

机构：

[1] Possible, New York, NY 10014 USA

[2] Brigham & Womens Hosp, Dept Med, Div Global Hlth Equ, 75 Francis St, Boston, MA 02115 USA

[3] Harvard Med Sch, Dept Med, Boston, MA 02115 USA

[4] Massachusetts Gen Hosp, Dept Med, Div Gen Internal Med, Boston, MA 02114 USA

[5] Univ Washington, Dept Global Hlth, Seattle, WA 98195 USA

[6] Univ Washington, Dept Anthropol, Seattle, WA 98195 USA

[7] Univ Washington, Henry M Jackson Sch Int Studies, Seattle, WA 98195 USA

[8] Icahn Sch Med Mt Sinai, Arnhold Inst Global Hlth, New York, NY 10029 USA

[9] Nyaya Hlth Nepal, Kathmandu, Nepal

[10] Univ Calif San Francisco, Dept Psychiat, San Francisco, CA USA

[11] Penn State Univ, Coll Hlth & Human Dev, Dept Hlth Policy & Adm, University Pk, PA 16802 USA

[12] Nepal Hlth Res Council, Kathmandu, Nepal

[13] Univ Calif San Francisco, Hlth Equ Act Leadership Initiat, San Francisco, CA 94143 USA

[14] Eastern Univ, Coll Leadership & Dev, St Davids, PA USA

[15] Icahn Sch Med Mt Sinai, Dept Hlth Syst Design & Global Hlth, New York, NY 10029 USA

[16] Icahn Sch Med Mt Sinai, Dept Internal Med, New York, NY 10029 USA

[17] Icahn Sch Med Mt Sinai, Dept Pediat, New York, NY 10029 USA

[18] Harvard TH Chan Sch Publ Hlth, Boston, MA USA

[19] Beth Israel Deaconess Med Ctr, Dept Med, Boston, MA 02215 USA

[20] Harvard TH Chan Sch Publ Hlth, Ariadne Labs, Boston, MA USA

[21] Brigham & Womens Hosp, 75 Francis St, Boston, MA 02115 USA

[22] Univ New South Wales, Sch Publ Hlth & Community Med, Sydney, NSW, Australia

[23] Dept Hlth Serv, Nursing & Social Secur Div, Kathmandu, Nepal

[24] Univ Penn, Perelman Sch Med, Philadelphia, PA 19104 USA

[25] Univ Penn, Wharton Sch, Healthcare Management Dept, Philadelphia, PA 19104 USA

[26] Icahn Sch Med Mt Sinai, Dept Obstet Gynecol & Reprod Sci, New York, NY 10029 USA

来源：

GLOBAL HEALTH-SCIENCE AND PRACTICE | 2020年 / 8卷 / 02期

基金：

美国国家卫生研究院;

关键词：

SUSTAINABLE DEVELOPMENT GOALS; CARE; MODEL;

D O I：

10.9745/GHSP-D-19-00393

中图分类号：

R1 [预防医学、卫生学];

学科分类号：

1004 ; 120402 ;

摘要：

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.

引用

页码：239 / 255

页数：17

共 40 条

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