We are a network of researchers based in both Northern and Southern academic institutions who are trained in economics, health economics, and closely allied disciplines with a track record in investigating the market for community health workers, community volunteers, and other close-to-community providers.
Our network aims to offer insight and support to institutions and individuals who want to better understand the economic characteristics of close to community providers in low- and middle-income settings. We are concerned with the economic drivers that determine whether close-to-community providers are able to provide good quality services in an affordable and sustainable way.
Using both quantitative and qualitative methods we investigate the role of close-to-community providers from three perspectives:
- Labour markets - to better understand the demand, supply and performance of close-to-community providers
- The economics of human resources - to assess the impact of factors such as workforce distribution, incentives, remuneration and management structures on close-to-community providers’ roles and responsibilities
- Costing and cost effectiveness -
- to assess the budgetary impact and efficient allocation of limited resources across competing demands
Ijeoma Edoka is a research fellow in health economics at the Institute for International Health and Development, Queen Margaret University, Edinburgh. Her research focuses on understanding the economic determinants of the distribution and performance of the health workforce in LMICs as well as in understanding the interplay of various factors that contribute to the effectiveness and cost-effectiveness of community health worker programmes. She led a team of health economists in developing a costing tool and an economic evaluation model of community health worker programmes in Ethiopia, Indonesia and Kenya. Ijeoma also has extensive experience applying advanced econometric methods to evaluate the impact of health policies. She is currently involved in the ReBUILD programme, investigating the impact of health financing policies in Sierra Leone, Uganda and Cambodia.
- McPake Barbara, Scott Anthony, Edoka Ijeoma (2014) Analysing Markets for Health Workers: Insights from Labor and Health Economics. The World Bank, Washington DC.
- McPake, B., Edoka, I., Witter, S. et al (2014) Are CHW programmes cost-effective in LMICs? Insights from a multi-country study in Kenya, Indonesia, and Ethiopia. Report for Global Health Workforce Alliance.
- McPake, Barbara and Edoka, Ijeoma (2014). Using financing to strengthen the health workforce: What has worked and why? Report for World Health Organisation, South East Asia Region.
Lesong Conteh is a senior lecturer in Health Economics at Imperial College London. Her research focuses on health economics and health system research mostly in sub-Saharan Africa, and includes coordinating multi-country economic evaluations to identify the costs, cost effectiveness and equity implications of introducing interventions via different delivery strategies; understanding the market of community health workers and exploring if and how their behaviour is influenced by financial and non-financial incentives and; comparing and contrasting consumer and provider interpretations of quality in health care delivery.
Past research on close-to-community providers has included compiling the economic evidence on Seasonal Malaria Chemoprevention (SMC). This work was conducted alongside randomised control trials to assess the costs, cost effectiveness and feasibility of scaling up Community Health Worker networks to reach children at risk from malaria in the Sahel. In 2012SMC was recommended by the World Health Ogranization as a strategy for consideration in certain settings.
- Pitt, C; NDiaye, M; Patouillard, E; Milligan, P; Conteh, L (2011) Economic Report for the WHO Technical Expert Group Meeting on Intermittent Preventive Treatment of Malaria in Children. Other. WHO.
- Pitt C., Diawara H., Ouédraogo D., Dicko A., Konaté A., Traoré A., Chandramohan D., Diallo D., Greenwood B., Conteh L., (2012) Intermittent Preventive Treatment of Malaria in Children: A Qualitative Study of Community Perceptions and Recommendations in Burkina Faso and Mali. PLoS ONE 7(3): e32900. doi:10.1371/journal.pone.0032900
- Patouillard E., Conteh L., Webster J., Kweku M., Chandramohan D., Greenwood B. (2011) Coverage, Adherence and Costs of Intermittent Preventive Treatment of Malaria in Children Employing Different Delivery Strategies in Jasikan, Ghana. PloS ONE6(11): e24871. doi:10.1371/journal.pone.0024871
- Bojang KA, Akor F, Conteh L, Webb E, Bittaye O, Conway D., Jasseh M., Wiseman V., Milligan P., Greenwood B. (2011) Two Strategies for the Delivery of IPTc in an Area of Seasonal Malaria Transmission in The Gambia: A Randomised Controlled Trial. PLoS Med 8(2): e1000409.
- Kallander K,, Tibenderana J, Akpogheneta O. Strachan D., Hill Z.ten Asbroek H., Conteh L., Kirkwood B., Meek S. (2013) Landscape analysis of mobile Health (mHealth) approaches and lessons for increased performance and retention of community health workers in low- and middle-income country settings. Journal of Medical Internet Research 15(1):e17) doi:10.2196/jmir.2130
- Strachan D., Kallander K,, ten Asbroek H., Kirkwood B., Meek S., Benton L., Conteh L., Tibenderana J,Hill Z. (2012) Interventions to improve motivation and retention of community health workers delivering Integrated Community Case Management (iCCM): stakeholder perceptions and priorities. Am J Trop Med Hyg. 87(5 Suppl):111-9. doi: 10.4269/ajtmh.2012.12-0030.
COSMIC aims to bring health services close to where pregnant women live, using community health workers to provide an antimalarial intervention to women with difficult access to the formal health system in Benin, Burkina Faso and The Gambia. Lesong Conteh is the PI for the Health Economics work package of the EU funded study and is working along side Dr Laetitia Duval to:
- Conduct an economic evaluation combining epidemiological outcomes with costs to both the health system.
- Undertake a threshold analysis to explore at which point the intervention is no longer cost effective given changing epidemiological and economic parameters.
- Explore the affordability of the intervention and the impact of its scaling up on government health budgeting.
- Provide insight into how equitable, sustainable and amenable to scale up the intervention is.
Miriam Taegtmeyer is a senior clinical lecturer at the Liverpool School of Tropical Medicine. She offers a unique skills mix, having trained as a doctor, a teacher and as a researcher. She has led a range of community-based research studies in Africa, focusing on HIV and including studies of HIV testing and counselling and on intimate partner violence (IPV). She has worked extensively with Ministries of Health in quality improvement and operational and strategic planning exercises at national level. She is on a number of World Health Organization guidelines groups on HIV. Miriam leads mixed method research that contributes to policy debates in community health and is the coordinator of REACHOUT, a European Union funded grant researching the equity, effectiveness and efficiency of close to community providers. She currently supervises three PhD students on IPV, HIV-related and community health topics.
- Marum E, Taegtmeyer M. Chebet K. Scale up of voluntary HIV counselling and testing in Kenya. JAMA. 2006;296:859-62. Theobald S, Raven J, Tolhurst R, Makwiza I, Taegtmeyer M Public health approach to HIV treatment in resource-poor settings. Lancet. 2006;368:1064.
- Taegtmeyer M, Suckling RM, Nguku PM, Meredith C, Kibaru J, Chakaya JM, Muchela H, Gilks CF. Working with risk: Occupational safety issues among healthcare workers in Kenya. AIDS Care. 2008 Mar; 20(3):304-10.
- Marum E, Morgan G, Hightower A, Angala P, Kamau P,Taegtmeyer M. Using mass media campaigns to promote voluntary counselling and HIV-testing services in Kenya. AIDS. 2008; 22(15):2019-24.
- Kilonzo N, Theobald SJ, Nyamato E, Ajema C, Muchela H, Kibaru J, Rogena E, Taegtmeyer M. Delivering post-rape care services: Kenya's experience in developing integrated services. Bull World Health Organ. 2009 Jul;87(7):555-9.
- Grabbe KL, Menzies N, Taegtmeyer M, Emukule G, Angala P, Mwega I, Musango G, Marum E. Increasing access to HIV counseling and testing through mobile services in Kenya: strategies, uptake and cost-effectiveness. J Acquir Immune Dedic Syndr. 2010 Jul 1; 54 (3):317-23.
- Macpherson P, Lalloo DG, Thindwa D, Webb EL, Squire SB, Chipungu GA, Desmond N, Makombe SD, Taegtmeyer M, Choko AT, Corbett EL. A novel community health worker tool outperforms WHO clinical staging for assessment of antiretroviral therapy eligibility in a resource-limited setting. J Acquir Immune Defic Syndr. 2014 Feb 1;65(2):e74-8.
- Munthali C, TaegtmeyerM, Garner P, Lalloo D, Squire BS, Corbett EL, Ford N, MacPherson P. Diagnostic accuracy of the WHO clinical staging system for defining eligibility for ART in sub-Saharan Africa: a systematic review and meta-analysis. J Int AIDS Soc. 2014 Jun 12;17(1):18932. doi: 10.7448/IAS.17.1.18932. eCollection.
- Peck RB, Lim JM, van Rooyen H, Mukoma W, Chepuka L, Bansil P, Knight LC, Muturi N, Chirwa E, Lee AM, Wellhausen JD, Tulloch O, Taegtmeyer M. What Should the Ideal HIV Self-Test Look Like? A Usability Study of Test Prototypes in Unsupervised HIV Self-Testing in Kenya, Malawi, and South Africa. AIDS Behav. 2014 Jul;18 Suppl 4:422-32.
- Johnson C, Baggaley R, Forsythe S, van Rooyen H, Ford N, Napierala Mavedzenge S, Corbett E, Natarajan P, Taegtmeyer M. Realizing the Potential for HIV Self-Testing. AIDS Behav. 2014 Jul;18 Suppl 4:391-5.
Kelsey Vaughan, MSc, MPP, is a health economist and health policy specialist. Ms Vaughan has seven years of experience in government, universities, research institutions and private consultancies in Europe, Latin America and the United States. She has provided technical assistance on health systems issues to Latin American governments, Bill & Melinda Gates Foundation, UNAIDS, WHO, World Bank and private companies. Ms Vaughan has been involved in a variety of health systems strengthening technical assistance projects and has performed a variety of studies in the field of health economics including financial analyses, costing, cost-effectiveness and value for money studies in Democratic Republic of Congo, Ethiopia, Guatemala, Indonesia, Malawi, Namibia, the Netherlands, Nigeria, Somalia, Tanzania and Zimbabwe.
Kelsey was the lead health economist providing technical assistance to the Ministry of Health and Social Service in Namibia to conduct an external assessment of cost-effectiveness of various community-based TB care activities implemented by different organisations. She developed the methodology and tools, conducted fieldwork, supervised national consultants, analyzed and validated data and presented findings and policy implications at stakeholder workshop. With Queen Margaret University she undertook a literature review of methodologies for, and results of assessing costs and cost-effectiveness of, community health workers. She helped to develop a model to assess the cost-effectiveness of community health worker programmes in three countries. She was involved in the collection and analysis of cost data for two districts in Indonesia.
Sophie Witter is Professor of International Health Financing and Health Systems at Queen Margaret University, Edinburgh. She is a health economist working on labour markets for health, within wider health system research, in low and middle income countries. She was part of a Queen Margaret University/Liverpool School of Tropical Medicine/KIT team which recently developed a costing model and undertook a study of cost-effectiveness of community health workers in three countries. She is also currently working with the Liverpool School of Tropical Medicine on an exploratory study of community health workers and human resource management in four African countries.
In the ReBUILD programme, her focus is on tracing the evolution of health worker incentives as health systems emerge from conflict. She has also focussed in her work on the interaction of changing health financing policies and human resources. Within the FEMHealth project, she lead a team studying the effects of fee removal on staff and the wider health system in four francophone African countries. Similarly, she contributed to a study for the UK Department for International Development in 2012 on "Removing financial barriers to access reproductive, maternal and newborn health services: the challenges and policy implications for Human Resources for Health". Her evaluations and systematic review of performance-based financing have also contributed to better understanding and study of this contested area.
- McPake, B., Edoka, I, Witter, S. et al. (2014) Economic Evaluation of Community Health Worker Programmes in low- and middle-income countries: a systematic literature review, country case studies and a generalized cost-effectiveness model. Report for GHWA.
- Namakula, J. and Witter, S. (2014) Living through conflict and post-conflict: experiences of health workers in northern Uganda and lessons for people-centred health systems. Health Policy and Planning special edition on People-Centred Health Systems.
- Bertone, M., Samai, M., Edem-Hotah, J. and Witter, S. (2014) A window of opportunity for reform in post-conflict settings? The case of Human Resources for Health policies in Sierra Leone, 2002-2012. Conflict and Health 8:11.
- Cometto, G. And Witter, S. (2013) Tackling health workforce challenges to universal health coverage: setting targets and measuring progress. WHO Bulletin special edition on HRH and UHC, vol. 3;91:881–885.
- McPake, B., Witter, S., Ensor, T., Fustukian, S., Newlands, D., Martineau, T. (2013) Removing financial barriers to access reproductive, maternal and newborn health services: the challenges and policy implications for human resources. Human Resources for Health, 11(1):46.
- Chirwa, Y., Witter, S., Munjoma, M., Mashange, W., Ensor, T., McPake, B., Munyati, S. (2013) The human resource implications of improving financial risk protection for mothers and newborns in Zimbabwe. BMC Health Services Research
- Fox, S., Witter, S., Wylde, E., Mafuta, E., Lievens, T. (2013) Paying for performance in a fragmented, fragile state: reflections from Katanga Province, Democratic Republic of Congo. Health Policy and Planning. doi: 10.1093/heapol/czs138
- Witter, S., Cometto, G., Zaman, R., Sheikh, M., Wibulpolprasert, S. (2013) Implementing the Agenda for Global Action on human resources for health: analysis from an international tracking survey. Journal of Hospital Administration, vol. 2, no. 1, p. 77-87.
- Witter, S., Fretheim, A., Kessy, F., Lindahl, A.K. (2012) Paying for performance to improve the delivery of health interventions in low and middle-income countries. Cochrane Database of Systematic Reviews, Issue 2.
- Asabir, K., Witter,S., Herbst, C., Dedzo, M. (2012) The Performance of Health Care Workers. Chapter 4 in ‘Towards interventions on HRH in Ghana: evidence for health workforce planning and results’. Appiah-Denkyira, E. et al. eds. Directions in Development. Washington, DC: World Bank. doi:10.1596/978-0-8213-9667-4.
- Witter, S., Zulfiquar, T., Javeed, S., Khan, A., Bar, A. (2011) Paying health workers for performance: a district-based case study in Pakistan. Human Resources for Health journal, 9, 23.
- Witter, S., Ha, B.T., Shengalia, B., Vujicic, M. (2011) Understanding the ‘four directions of travel’: qualitative research into the factors affecting retention of doctors in rural Vietnam. Human Resources for Health, 9, 20.
- De Brouwere, V., Dieng, T., Diadhiou, M., Witter, S., Denerville, E. (2009) Task shifting in emergency obstetric surgery: results from a national evaluation in Senegal. Reproductive Health Matters, vol. 17 (33), pp. 32–44.
- McCoy, D., Bennett, S., Witter, S. et al. (2008) Health worker salaries and incomes in sub-Saharan Africa. The Lancet, vol 371, p. 677-83.
- Witter, S., Kusi, A. and Aikins, M. (2007) Effects of a delivery exemption scheme on workloads and incomes of health workers in Ghana. Human Resources for Health journal, vol 5; 2.
Elvis Gama is a health economist at the Centre for Applied Health Research and Delivery (CAHRD), Liverpool School of Tropical Medicine, based in Liverpool, UK. He received his PhD from Queen Margaret University in the United Kingdom and specialises in health care financing in low- and middle-income countries, health systems management, costing of healthcare interventions, evaluating the effectiveness of health care interventions, alternative healthcare financing mechanisms, contracting out of healthcare services to private health care providers, applied econometrics and health policy. He worked as a lead researcher on a WHO funded project and has experience as a consultant working in Nigeria and Sierra Leone on DFID funded projects. Elvis is presently working on Economic Evaluation of Community Health Worker Programmes in low- and middle-income countries (Malawi, Kenya, Mozambique, Ethiopia, Indonesia and Bangladesh); TRIAGE clinical trial, an economic evaluation of practical approach to lung health and informal provider interventions for improving the detection of tuberculosis and chronic airways disease at primary care level in Malawi and Sudan; STREAM clinical trial, an economic evaluation of a standardised treatment regimen of anti-tuberculosis drugs for patient with multi-drug-resistance tuberculosis (MDR-TB) in Ethiopia and South Africa.
- Economic Evaluation of Community Health Worker Programmes in Low- and Middle-Income Countries: A Systematic Literature Review, country case studies and a generalized cost-effectiveness model, Report Submitted to WHO
- Gama E. (2014) Health insecurity: Are social protection policies reducing catastrophic healthcare expenditure in disenfranchised communities? Manuscript under review, Publication expected September, 2014
- Gama E., Madan J., Squire B., Thomson R., and Namakhoma I. (2014) Economic evaluation of practical approach to lung health and informal provider interventions for improving the detection of tuberculosis and chronic airways disease at primary care level in Malawi: Study protocol for cost-effectiveness analysis, Manuscript under review, Publication expected September, 2014
- Gama E. and McPake B. (2014) The implications of contracting out health care services: The case of service level agreements in Malawi, http://mpra.ub.uni-muenchen.de/52980/, Manuscript under review, Publication expected October 2014
- Gama E. (2013) The implications of contracting out health care provision to private not-for- profit health care providers: the case of service level agreements in Malawi, PhD thesis
Photo courtsey of Earl https://www.flickr.com/photos/earlg/182538685