Costing analysis of a pilot community health worker program in Rural Nepal

Prajwol Nepal, Ryan Schwarz, David Citrin, Aradhana Thapa, Bibhav Acharya, Yubraj Acharya, Anu Aryal, Aaron Baum, Ved Bhandari, Laxman Bhatt, Dipak Bhattarai, Nandini Choudhury, Binod Dangal, Meghnath Dhimal, Santosh Kumar Dhungana, Bikash Gauchan, Scott Halliday, S. P. Kalaunee, Lal Bahadur Kunwar, Duncan MaruIsha Nirola, Rashmi Paudel, Anant Raut, Hari Jung Rayamazi, Sabitri Sapkota, Dan Schwarz, Poshan Thapa, Pratistha Thapa, Aparna Tiwari, Roshani Tuitui, Eric Walter, Sheela Maru

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Community health workers (CHWs) are essential to primary health care systems and are a cost-effective strategy to achieve the Sustainable Development Goals (SDGs). Nepal is strongly committed to universal health coverage and the SDGs. In 2017, the Nepal Ministry of Health and Population partnered with the nongovernmental organization Nyaya Health Nepal to pilot a program aligned with the 2018 World Health Organization guidelines for CHWs. The program includes CHWs who: (1) receive regular financial compensation; (2) meet a minimum education level; (3) are well supervised; (4) are continuously trained; (5) are integrated into local primary health care systems; (6) use mobile health tools; (7) have consistent supply chain; (8) live in the communities they serve; and (9) provide service without point-of-care user fees. The pilot model has previously demonstrated improved institutional birth rate, antenatal care completion, and postpartum contraception utilization. Here, we performed a retrospective costing analysis from July 16, 2017 to July 15, 2018, in a catchment area population of 60, 000. The average per capita annual cost is US$3.05 (range: US$1.94 to US$4.70 across 24 villages) of which 74% is personnel cost. Service delivery and administrative costs and per beneficiary costs for all services are also described. To address the current discourse among Nepali policy makers at the local and federal levels, we also present 3 alternative implementation scenarios that policy makers may consider. Given the Government of Nepal's commitment to increase health care spending (US$51.00 per capita) to 7.0% of the 2030 gross domestic product, paired with recent health care systems decentralization leading to expanded fiscal space in municipalities, this CHW program provides a feasible opportunity to make progress toward achieving universal health coverage and the health-related SDGs. This costing analysis offers insights and practical considerations for policy makers and locally elected officials for deploying a CHW cadre as a mechanism to achieve the SDG targets.

Original languageEnglish (US)
Pages (from-to)239-255
Number of pages17
JournalGlobal health, science and practice
Issue number2
StatePublished - Jun 2020

All Science Journal Classification (ASJC) codes

  • Health Policy
  • Public Health, Environmental and Occupational Health


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