Last Mile Health recently conducted an economic evaluation of the National Community Health Assistant Program in Liberia. The study examines actual costs and economic impact of the first two years of program implementation in Grand Bassa County, one of the three counties where Last Mile Health directly manages the implementation of the national program. The study provides valuable costing information for planning and decision-making as the program scales.
The national program was launched in Grand Bassa County in August 2017, leading to the recruitment, training, and deployment of 258 community health workers and 25 supervisors. Together, they serve 64,917 people living in 278 communities. The study reviews cost data from program launch through June 2019.
Importantly, study findings show that the investment – defined as the total cost of launching and implementing the program in the county – has produced an early impact on health outputs and outcomes, such as malaria diagnostic testing and treatment of childhood illness, and additional impact is expected over time. In addition, increasing the number of health facilities to reach rural communities and deliver similar essential health services would be about twice as much as the cost of the national program.
Under current cost structures, there is no scenario in which an increase in the number of health facilities could be as cost-effective as the national program to increase the use of malaria diagnostic testing and treatment of childhood illness by a formal provider.
Study results have provided practical data that we can use alongside our partners to inform program implementation and sustainability strategies. Liberia’s Ministry of Health is currently reviewing its National Community Health Services policy, and study data is being used to help produce cost estimations, understand trade-offs, and make decisions to make community health programming more impactful for the communities served. For example, study data can be used to estimate and compare the costs of adding new services to the program under different scenarios, in turn helping to assess which implementation options are the most feasible and cost-effective. Study data is also being used by Liberia’s Ministry of Health and partners as a basis to better understand program cost structures over time and how much funders could expect to spend, continuously informing the program’s financial sustainability strategies in its pathway to scale. We expect that study results will continue to inform decisions that improve the impact, effectiveness, and sustainability of the program.