Plain Language Summary

What is it about? Healthcare systems worldwide face increasing pressure due to factors such as population aging, resource limitations, and workforce shortages. Community health workers are seen as a potential solution to these challenges, especially in vulnerable populations that lack access to adequate care. Existing literature indicates community health workers can improve health outcomes, but there is a need to evaluate their value-for-money. This study investigates the published literature on the cost-effectiveness of community health worker programs compared to usual care in primary healthcare settings globally. The research aims to inform healthcare decision makers on the potential benefits of integrating community health workers into primary healthcare systems.

How was the research conducted? The study was based on a systematic literature review methodology, which involved collecting and analyzing data from 5 major electronic bibliographic databases. Selected articles met specific criteria, such as focusing on community health worker interventions in primary healthcare and providing full economic evaluations. Data were extracted using a standardized template and assessed for reporting quality based on established reporting standards. The review includes both trial-based and model-based analyses, comparing community health worker interventions to usual care across diverse settings and populations. This method was chosen to provide a comprehensive overview of the available evidence and to identify trends and gaps in the literature.

What were the results? The review included 50 articles from 25 countries, with most studies indicating that community health workers’ interventions are cost-effective in various health domains, such as maternal and child health, type 2 diabetes, cardiovascular disease, mental health, tuberculosis, and HIV. Community health worker programs were found to be particularly cost-effective in low- and middle-income countries but also showed promise in high-income settings. However, the variation in contexts and methodologies makes it challenging to draw generalized conclusions. An unexpected finding was the limited use of probabilistic sensitivity analysis in many studies, which is crucial for assessing the robustness of cost-effectiveness estimates.

Why are the results important? These findings are significant for different stakeholders, such as governments, health technology assessment agencies, and healthcare providers, as they highlight the potential of community health workers to improve health outcomes cost-effectively. Integrating community health workers into primary healthcare can lead to practical changes in clinical practice, such as improved access to care and reduced health inequities. Long-term, these results could influence policy reforms aimed at strengthening primary healthcare systems and achieving sustainable development goals.

What are the strengths and weaknesses of this study? The study's main strength lies in its comprehensive review of diverse community health worker interventions across multiple health domains and geographic contexts. However, a key limitation is the heterogeneity in study designs and methodologies, which affects the ability to generalize findings. Future research should focus on standardizing evaluation methods and conducting more probabilistic sensitivity analyses to enhance the reliability of cost-effectiveness estimates, while further exploring community health workers’ role in high-income countries.

This systematic review provides valuable insights into the value-for-money of community health workers in primary healthcare, offering evidence to support their integration into health systems to improve access and equity for underserved populations.

^{Note: This content was created with assistance from artificial intelligence (AI) and has been reviewed and edited by ISPOR staff. For more information or for inquiries on ISPOR’s AI policy, click here or contact us at info@ispor.org.}