Valuing the work of unpaid community health workers and exploring the incentives to volunteering in rural Africa
Identifieur interne : 000364 ( Pmc/Curation ); précédent : 000363; suivant : 000365Valuing the work of unpaid community health workers and exploring the incentives to volunteering in rural Africa
Auteurs : Frida Kasteng [Royaume-Uni] ; Stella Settumba [Ouganda] ; Karin K Llander [Royaume-Uni, Suède, Ouganda] ; Anna Vassall [Royaume-Uni]Source :
- Health Policy and Planning [ 0268-1080 ] ; 2015.
Abstract
Community health worker (CHW) programmes are currently being scaled-up in sub-Saharan Africa to improve access to healthcare. CHWs are often volunteers; from an economic perspective, this raises considerations whether reliance on an unpaid workforce is sustainable and how to appropriately cost and value the work of CHWs. Both these questions can be informed by an understanding of CHWs’ workload, their opportunity costs of time and the perceived benefits of being a CHW. However, to date few studies have fully explored the methodological challenges in valuing CHW time. We examined the costs and benefits of volunteering in a sample of 45 CHWs providing integrated community case management of common childhood illnesses in rural Uganda in February 2012 using different methods. We assessed the value of CHW time using the minimum public sector salary rate and a CHW-elicited replacement wage, as well as the opportunity cost of time based on CHW-estimated annual income and alternative work opportunities, respectively. Reported monthly CHW workload, a median of 19.3 h (range 2.5–57), was valued at USD 6.9 (range 0.9–20.4) per month from the perspective of the healthcare system (applicable replacement wage) and at a median of USD 4.1 (range 0.4–169) from the perspective of the CHWs (individual opportunity cost of time). In a discrete choice experiment on preferred work characteristics, remuneration and community appreciation dominated. We find that volunteering CHWs value the opportunity to make a social contribution, but the decision to volunteer is also influenced by anticipated future rewards. Care must be taken by those costing and designing CHW programmes to acknowledge the opportunity cost of CHWs at the margin and over the long term. Failure to properly consider these issues may lead to cost estimations below the amount necessary to scale up and sustain programmes.
Url:
DOI: 10.1093/heapol/czv042
PubMed: 26001813
PubMed Central: 4748129
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<front><div type="abstract" xml:lang="en"><p>Community health worker (CHW) programmes are currently being scaled-up in sub-Saharan Africa to improve access to healthcare. CHWs are often volunteers; from an economic perspective, this raises considerations whether reliance on an unpaid workforce is sustainable and how to appropriately cost and value the work of CHWs. Both these questions can be informed by an understanding of CHWs’ workload, their opportunity costs of time and the perceived benefits of being a CHW. However, to date few studies have fully explored the methodological challenges in valuing CHW time. We examined the costs and benefits of volunteering in a sample of 45 CHWs providing integrated community case management of common childhood illnesses in rural Uganda in February 2012 using different methods. We assessed the value of CHW time using the minimum public sector salary rate and a CHW-elicited replacement wage, as well as the opportunity cost of time based on CHW-estimated annual income and alternative work opportunities, respectively. Reported monthly CHW workload, a median of 19.3 h (range 2.5–57), was valued at USD 6.9 (range 0.9–20.4) per month from the perspective of the healthcare system (applicable replacement wage) and at a median of USD 4.1 (range 0.4–169) from the perspective of the CHWs (individual opportunity cost of time). In a discrete choice experiment on preferred work characteristics, remuneration and community appreciation dominated. We find that volunteering CHWs value the opportunity to make a social contribution, but the decision to volunteer is also influenced by anticipated future rewards. Care must be taken by those costing and designing CHW programmes to acknowledge the opportunity cost of CHWs at the margin and over the long term. Failure to properly consider these issues may lead to cost estimations below the amount necessary to scale up and sustain programmes.</p>
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<pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Health Policy Plan</journal-id>
<journal-id journal-id-type="iso-abbrev">Health Policy Plan</journal-id>
<journal-id journal-id-type="publisher-id">heapol</journal-id>
<journal-id journal-id-type="hwp">heapol</journal-id>
<journal-title-group><journal-title>Health Policy and Planning</journal-title>
</journal-title-group>
<issn pub-type="ppub">0268-1080</issn>
<issn pub-type="epub">1460-2237</issn>
<publisher><publisher-name>Oxford University Press</publisher-name>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">26001813</article-id>
<article-id pub-id-type="pmc">4748129</article-id>
<article-id pub-id-type="doi">10.1093/heapol/czv042</article-id>
<article-id pub-id-type="publisher-id">czv042</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Original Articles</subject>
</subj-group>
<series-title>Editor's Choice</series-title>
</article-categories>
<title-group><article-title>Valuing the work of unpaid community health workers and exploring the incentives to volunteering in rural Africa</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Kasteng</surname>
<given-names>Frida</given-names>
</name>
<xref ref-type="aff" rid="czv042-AFF1"><sup>1</sup>
</xref>
<xref ref-type="corresp" rid="czv042-COR1"><sup>*</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Settumba</surname>
<given-names>Stella</given-names>
</name>
<xref ref-type="aff" rid="czv042-AFF2"><sup>2</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Källander</surname>
<given-names>Karin</given-names>
</name>
<xref ref-type="aff" rid="czv042-AFF3"><sup>3</sup>
</xref>
<xref ref-type="aff" rid="czv042-AFF4"><sup>4</sup>
</xref>
<xref ref-type="aff" rid="czv042-AFF5"><sup>5</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Vassall</surname>
<given-names>Anna</given-names>
</name>
<xref ref-type="aff" rid="czv042-AFF6"><sup>6</sup>
</xref>
</contrib>
<contrib contrib-type="author"><collab>the inSCALE Study Group</collab>
<xref ref-type="author-notes" rid="czv042-FN1"><sup>†</sup>
</xref>
</contrib>
<aff id="czv042-AFF1"><sup>1</sup>
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Health Economics and Systems Analysis Group, London, UK,</aff>
<aff id="czv042-AFF2"><sup>2</sup>
Malaria Consortium Uganda, Kampala, Uganda,</aff>
<aff id="czv042-AFF3"><sup>3</sup>
Malaria Consortium, London, UK,</aff>
<aff id="czv042-AFF4"><sup>4</sup>
Department of Public Health Sciences, Karolinska Institutet, Health Systems and Policy group, Stockholm, Sweden,</aff>
<aff id="czv042-AFF5"><sup>5</sup>
Department of Epidemiology and Biostatistics, Makerere University College of Health Sciences, Kampala, Uganda, and</aff>
<aff id="czv042-AFF6"><sup>6</sup>
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Social and Mathematical Epidemiology Group, London, UK</aff>
</contrib-group>
<author-notes><corresp id="czv042-COR1">*Corresponding author. London School of Hygiene and Tropical Medicine, Department of Global Health and Development, 15-17 Tavistock Place, London WC1H 9SH, UK. E-mail: <email>frida.kasteng@lshtm.ac.uk</email>
</corresp>
<fn id="czv042-FN1"><p><sup>†</sup>
The members of the inSCALE Study Group are listed in the Acknowledgements.</p>
</fn>
</author-notes>
<pub-date pub-type="ppub"><month>3</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="epub"><day>22</day>
<month>5</month>
<year>2015</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>22</day>
<month>5</month>
<year>2015</year>
</pub-date>
<pmc-comment> PMC Release delay is 0 months and 0 days and was based on the
. </pmc-comment>
<volume>31</volume>
<issue>2</issue>
<fpage>205</fpage>
<lpage>216</lpage>
<history><date date-type="accepted"><day>9</day>
<month>4</month>
<year>2015</year>
</date>
</history>
<permissions><copyright-statement>© The Author 2015. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.</copyright-statement>
<copyright-year>2015</copyright-year>
<license xlink:href="http://creativecommons.org/licenses/by-nc/4.0/" license-type="creative-commons"><license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/4.0/">http://creativecommons.org/licenses/by-nc/4.0/</ext-link>
), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com</license-p>
</license>
</permissions>
<abstract><p>Community health worker (CHW) programmes are currently being scaled-up in sub-Saharan Africa to improve access to healthcare. CHWs are often volunteers; from an economic perspective, this raises considerations whether reliance on an unpaid workforce is sustainable and how to appropriately cost and value the work of CHWs. Both these questions can be informed by an understanding of CHWs’ workload, their opportunity costs of time and the perceived benefits of being a CHW. However, to date few studies have fully explored the methodological challenges in valuing CHW time. We examined the costs and benefits of volunteering in a sample of 45 CHWs providing integrated community case management of common childhood illnesses in rural Uganda in February 2012 using different methods. We assessed the value of CHW time using the minimum public sector salary rate and a CHW-elicited replacement wage, as well as the opportunity cost of time based on CHW-estimated annual income and alternative work opportunities, respectively. Reported monthly CHW workload, a median of 19.3 h (range 2.5–57), was valued at USD 6.9 (range 0.9–20.4) per month from the perspective of the healthcare system (applicable replacement wage) and at a median of USD 4.1 (range 0.4–169) from the perspective of the CHWs (individual opportunity cost of time). In a discrete choice experiment on preferred work characteristics, remuneration and community appreciation dominated. We find that volunteering CHWs value the opportunity to make a social contribution, but the decision to volunteer is also influenced by anticipated future rewards. Care must be taken by those costing and designing CHW programmes to acknowledge the opportunity cost of CHWs at the margin and over the long term. Failure to properly consider these issues may lead to cost estimations below the amount necessary to scale up and sustain programmes.</p>
</abstract>
<kwd-group><kwd>Child health</kwd>
<kwd>community health workers</kwd>
<kwd>integrated community case management</kwd>
<kwd>opportunity costs</kwd>
<kwd>volunteers</kwd>
<kwd>Uganda</kwd>
</kwd-group>
<counts><page-count count="12"></page-count>
</counts>
</article-meta>
</front>
</pmc>
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