Save the Children, Washington, DC, USA.
London School of Hygiene and Tropical Medicine, MARCH Centre, London, UK.
Health Policy Plan. 2017 Oct 1;32(suppl_1):i84-i92. doi: 10.1093/heapol/czx038.
Community-based maternal and newborn care with home visits by community health workers (CHWs) are recommended by WHO to complement facility-based care. As part of multi-country economic and systems analyses, we aimed to compare the content and financial costs associated with equipping CHWs or 'home visit kits' from seven studies in Bolivia, Ethiopia, Ghana, Malawi, South Africa, Tanzania and Uganda. We estimated the equivalent annual costs (EACs) of home visit kits per CHW in constant 2015 USD. We estimated EAC at scale in a population of 100 000 assuming four home visits per mother during the pregnancy and postnatal period. All seven packages were designed for health promotion; six included clinical assessments and one included curative care. The items used by CHWs differed between countries, even for the same task. The EAC per home visit kit ranged from $15 in Tanzania to $116 in South Africa. For health promotion and preventive care, between 82 and 100% of the cost of CHW commodities did not vary with the number of home visits conducted; however, in Ethiopia, the majority of EAC associated with curative care varied with the number of visits conducted. The EAC of equipping CHWs to meet the needs of 95% of expectant mothers in a catchment area of 100 000 people was highest in Bolivia, $40 260 for 633 CHWs, due to mothers being in hard-to-reach areas with CHW conducting few visits per year per, and lowest in Tanzania ($2693 for 172 CHWs), due to the greater number of CHW visits per week and lower EAC of items. To inform and ensure sustainable implementation at scale, national discussions regarding the cadre of CHWs and their workload should also consider carefully the composition and cost of equipping CHWs to carry out their work effectively and efficiently.
社区卫生工作者（CHW）提供的基于社区的母婴保健和家访服务，被世界卫生组织推荐作为医疗机构护理的补充。作为多国经济和系统分析的一部分，我们旨在比较来自玻利维亚、埃塞俄比亚、加纳、马拉维、南非、坦桑尼亚和乌干达的 7 项研究中为 CHW 配备装备或“家访工具包”的相关内容和财务成本。我们使用 2015 年不变价美元估算了每位 CHW 家访工具包的等效年度成本（EAC）。我们按照 10 万人的规模进行了 EAC 的估算，假设每位产妇在妊娠和产后期间进行 4 次家访。所有 7 个工具包都是为促进健康而设计的；其中 6 个包括临床评估，1 个包括治疗护理。即使是相同的任务，CHW 使用的工具在不同国家也有所不同。家访工具包的 EAC 范围从坦桑尼亚的 15 美元到南非的 116 美元不等。对于健康促进和预防保健，CHW 商品的成本有 82%至 100%不随家访次数的变化而变化；然而，在埃塞俄比亚，与治疗护理相关的大部分 EAC 随家访次数的变化而变化。为满足服务半径为 10 万人的范围内 95%的孕妇的需求而装备 CHW 的 EAC 在玻利维亚最高，为 40260 美元，共装备 633 名 CHW，这是因为产妇位于难以到达的地区，且 CHW 每年为每位产妇进行的家访次数较少；在坦桑尼亚最低，为 172 名 CHW 的 2693 美元，这是因为每周家访次数更多，且工具的 EAC 较低。为了提供信息并确保在较大范围内可持续实施，关于 CHW 干部及其工作量的国家讨论也应仔细考虑有效和高效开展工作所需的 CHW 装备的组成和成本。
