Sally Findley’s presentation at the Community Health Worker Symposium in Uganda in February 2017 examined the cost-effectiveness of alternative models of community health workers in the promotion of maternal, newborn, and child health (MNCH) in Northern Nigeria. This research was based work conducted by the Women For Health programme, which aims to train 6,000 female health workers in the region to address the lack of health professionals in the hard-to-reach setting
Female community health workers (CHWs) are needed in the area, as there is a strong preference for a woman-to-woman approach in MNCH services. The presentation explained the different models of female CHW for the cost-effectiveness analysis:
- Community Volunteers (CVs) which are trained by the state and NGO partners to educate about primary health care, but can also be involved in vertical programmes such as malaria or immunisation. CVs are unpaid.
- SURE-P Maternal and Child Health Village Health Workers (MCH VHWs). These women are recruited by their village, but trained and mentored by a community health extension worker (CHEW) based at the primary health centre serving the area. The VHW visits homes to promote antenatal care and skilled birth attendance. They are volunteers, but receive a stipend.
- Junior CHEWs (JCHEWs), who deliver community-based services (CBSD) such as management of childhood illnesses and primary health care to homes in hard-to-reach communities. JCHEW-CBSDs are paid for full-time work.
The cost-effectiveness analysis found that the JCHEW-CBSDs had the highest cost; the VHWs cost 25% less; and the CVs had lowest costs. The VHWs, however, were the best for the basic maternal and child health outcomes, with the highest-cost benefit ratio. The presentation’s conclusion was that the VHW model shows most promise for supporting cost-effective MNCH care in Northern Nigeria. It recommended that support for the VHW model should be consolidated, that funding for VHWs should be increased, and that their training should be integrated under the National Community Health Practitioner Board.