Browsing by Person "Vaughan, Kelsey"

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Cost-effectiveness of community-based practitioner programmes in Ethiopia, Indonesia and Kenya
(World Health Organization, 2015-08-03) McPake, Barbara; Edoka, Ijeoma P.; Witter, Sophie; Kielmann, Karina; Taegtmeyer, Miriam; Dieleman, Marjolein; Vaughan, Kelsey; Gama, Elvis; Kok, Maryse; Datiko, Daniel; Otiso, Lillian; Ahmed, Rukhsana; Squires, Neil; Suraratdecha, Chutima; Cometto, Giorgio
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.
Costs and cost-effectiveness of community health workers: evidence from a literature review
(BioMed Central, 2015-09) Vaughan, Kelsey; Kok, Maryse C.; Witter, Sophie; Dieleman, Marjolein
Objective This study sought to synthesize and critically review evidence on costs and cost-effectiveness of community health worker (CHW) programmes in low- and middle-income countries (LMICs) to inform policy dialogue around their role in health systems. Methods From a larger systematic review on effectiveness and factors influencing performance of close-to-community providers, complemented by a supplementary search in PubMed, we did an exploratory review of a subset of papers (32 published primary studies and 4 reviews from the period January 2003-July 2015) about the costs and cost-effectiveness of CHWs. Studies were assessed using a data extraction matrix including methodological approach and findings. Results Existing evidence suggests that, compared with standard care, using CHWs in health programmes can be a cost-effective intervention in LMICs, particularly for tuberculosis, but also - although evidence is weaker - in other areas such as reproductive, maternal, newborn and child health (RMNCH) and malaria. Conclusion Notwithstanding important caveats about the heterogeneity of the studies and their methodological limitations, findings reinforce the hypothesis that CHWs may represent, in some settings, a cost-effective approach for the delivery of essential health services. The less conclusive evidence about the cost-effectiveness of CHWs in other areas may reflect that these areas have been evaluated less (and less rigorously) than others, rather than an actual difference in cost-effectiveness in the various service delivery areas or interventions. Methodologically, areas for further development include how to properly assess costs from a societal perspective rather than just through the lens of the cost to government and accounting for non-tangible costs and non-health benefits commonly associated with CHWs.
Costs and cost-effectiveness of integrated horizontal community health worker programmes in low- and middle-income countries (2015–2024): a scoping literature review
(BMJ Publishing Group, 2025-07-22) O’ Donovan, James; Kumar, Meghan Bruce; Ballard, Madeleine; Mchenga, Martina; Martin, Lily; Dennis, Mardieh; Mantus, Molly; Jiménez, Ariwame; Sirmareza, Trio; Cook, Jessica; Kawooya, Patrick; Aranda, Zeus; Ishimwe, Angele Bienvenue; Praha, Rizky Deco; Finnegan, Karen E.; Ruffing, Katherine; Kok, Maryse; Iberico, Matias; Palazuelos, Daniel; Witter, Sophie; Rao, Megha; Dhillon, Ranu S; Napier, Harriet G; Nkenfack, Marius; Katzen, Linnea Stansert; Makhupula, Lazola; Odera, Margaret; Nshimayesu, Michee; Vaughan, Kelsey
Background Community health workers (CHWs) play a vital role in delivering primary health care in low- and middle-income countries (LMICs), addressing multiple diseases through horizontal programmes. Despite their effectiveness, there is a US$4.4 billion annual funding gap for professional CHW programmes. Some countries have adopted these programmes, while others require stronger economic evidence to justify investments. This study updates a 2015 review, critically examining the costs and cost-effectiveness of horizontal CHW programmes in LMICs. Methods A scoping review was conducted using 10 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, cost and outcomes were extracted, tabulated in Microsoft Excel and analysed. Results A total of 18 studies, covering 42 scenarios, were included. Most studies focused on partial economic evaluations, with cost analyses being the most common method. CHW compensation varied widely, with a median monthly salary of US$265 (range US$3033 ($148 (Ethiopia)–$3181 (Malawi)); IQR US$346 (US$203–US$549)). The most commonly reported cost metric was the annual cost per capita, with a median of $6.02 (range: $0.29–$67.95). Sensitivity analyses were conducted in 29% of the scenarios, with six scenarios concluding CHW programmes were cost-effective. However, most did not conclude on cost-effectiveness or affordability, highlighting gaps in the evidence base. Service provision was the most frequently reported outcome, while cost per outcome and affordability were under-reported. Conclusions This review highlights gaps in the economic evaluation of horizontal CHW programmes, particularly in cost-effectiveness and affordability. More large-scale evaluations are needed to inform national health policies and support sustained investment in CHW programmes to strengthen health systems and address workforce shortages.
Performance-based financing as a health system reform: mapping the key dimensions for monitoring and evaluation
(BioMed Central, 2013-09-29) Witter, Sophie; Toonen, Jurrien; Meessen, Bruno; Kagubare, Jean; Fritsche, Gyrgy; Vaughan, Kelsey
Background Performance-based financing is increasingly being applied in a variety of contexts, with the expectation that it can improve the performance of health systems. However, while there is a growing literature on implementation issues and effects on outputs, there has been relatively little focus on interactions between PBF and health systems and how these should be studied. This paper aims to contribute to filling that gap by developing a framework for assessing the interactions between PBF and health systems, focusing on low and middle income countries. In doing so, it elaborates a general framework for monitoring and evaluating health system reforms in general. Methods This paper is based on an exploratory literature review and on the work of a group of academics and PBF practitioners. The group developed ideas for the monitoring and evaluation framework through exchange of emails and working documents. Ideas were further refined through discussion at the Health Systems Research symposium in Beijing in October 2012, through comments from members of the online PBF Community of Practice and Beijing participants, and through discussion with PBF experts in Bergen in June 2013. Results The paper starts with a discussion of definitions, to clarify the core concept of PBF and how the different terms are used. It then develops a framework for monitoring its interactions with the health system, structured around five domains of context, the development process, design, implementation and effects. Some of the key questions for monitoring and evaluation are highlighted, and a systematic approach to monitoring effects proposed, structured according to the health system pillars, but also according to inputs, processes and outputs. Conclusions The paper lays out a broad framework within which indicators can be prioritised for monitoring and evaluation of PBF or other health system reforms. It highlights the dynamic linkages between the domains and the different pillars. All of these are also framed within inter-sectoral and wider societal contexts. It highlights the importance of differentiating short term and long term effects, and also effects (intended and unintended) at different levels of the health system, and for different sectors and areas of the country. Outstanding work will include using and refining the framework and agreeing on the most important hypotheses to test using it, in relation to PBF but also other purchasing and provider payment reforms, as well as appropriate research methods to use for this task.