Affordability of comprehensive community health worker programmes in rural sub-Saharan Africa.
Affordability of comprehensive community health worker programmes in rural sub-Saharan Africa.
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DOI：
10.1136/bmjgh-2017-000391
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发表时间：
2017
影响因子：
8.1
通讯作者：
Lilford R
中科院分区：
文献类型：
--
作者：
Taylor C;Griffiths F;Lilford R
社区卫生工作者 (CHW) 计划的人均服务成本较低，对于实现全民医疗保健至关重要。然而，其总成本很高，并且未能实现到 2015 年为撒哈拉以南非洲地区提供 100 万社区卫生工作者的目标。我们通过估算相对于不同社区卫生工作者工资和可用于医疗保健的资源的国家医疗保健支出的总计划成本来考虑农村社区卫生工作者计划的承受能力。我们将现有的农村社区卫生工作者计划成本来源与世界银行数据相结合，估算 37 个国家的相对社区卫生工作者计划成本。我们考虑了三项“工资”（社区卫生工作者作为志愿者，每月支付相当于当地 80 美元的工资，并支付国家最低工资）和四项潜在的医疗保健预算（单独的实际拨款和阿布贾申报拨款，并分别根据收到的外部资金和潜在的外国援助增加）。成本按 2012 年名义美元计算。由于社区卫生工作者每月支付相当于当地 80 美元的费用，并由现有的中央政府医疗保健预算提供资金，因此社区卫生工作者计划的相对成本中位数将占医疗保健预算的 27%。虽然五个国家（博茨瓦纳、赤道几内亚、加蓬、纳米比亚和南非）的相对成本低于 2.5%，但三个国家（乍得、厄立特里亚和尼日尔）的相对成本将超过 100%。人均国内生产总值（GDP）的自然对数与承受能力之间存在很强的负线性关系（R2=0.83，p<0.001）。在人均 GDP 低于 1200 美元的 23 个国家中，如果社区卫生工作者每月支付 80 美元，那么社区卫生工作者计划的成本将超过实际医疗保健支出的 12%。社区卫生工作者可能是普及专业医疗保健的垫脚石，但撒哈拉以南非洲地区社区卫生工作者项目的承受能力存在很大差异。在许多国家，除非获得大量外国援助，否则此类计划尚无法负担。
Community health worker (CHW) programmes have low costs per person served and are central to achieving universal healthcare. However, their total cost is high and the target of one million CHWs for sub-Saharan Africa by 2015 was not met. We consider the affordability of rural CHW programmes by estimating total programme costs relative to national healthcare expenditure at different CHW salaries and resources available for healthcare. We combine an existing source of rural CHW programme costs with World Bank data to estimate relative CHW programme costs in 37 countries. We consider three ‘salaries’ (CHWs as volunteers, paid the local equivalent of US$80 per month and paid the national minimum wage) and four potential healthcare budgets (both actual and Abuja declaration allocations alone and increased by external funding received and potential foreign aid, respectively). Costs are shown in 2012 nominal US$. With CHWs paid the local equivalent of US$80 per month and financed from existing central government healthcare budgets, the median relative cost of a CHW programme would be 27% of the healthcare budget. While less than 2.5% in five countries (Botswana, Equatorial Guinea, Gabon, Namibia and South Africa), this relative cost would exceed 100% in three (Chad, Eritrea and Niger). There is a strong negative linear relationship (R2=0.83, p<0.001) between the natural logs of gross domestic product (GDP) per capita and affordability. In 23 countries with GDP per capita under US$1200, the cost of a CHW programme would exceed 12% of actual healthcare spending if CHWs were paid US$80 per month. CHWs may be a stepping stone to universal access to professional healthcare, but there is high variability in the affordability of CHW programmes across sub-Saharan Africa. In many countries, such programmes are not yet affordable unless significant foreign aid is received.