Time to prioritise community health workers: a decade of cost-effectiveness evidence
Governments in low-income and middle-income countries face a stark challenge: delivering quality health care within the shrinking fiscal space. Many governments default to facility-based, curative investments, yet this model alone cannot deliver universal health coverage. Hospitals often struggle to reach remote communities, deliver preventive care, and address social and behavioural drivers of disease—areas in which community health workers (CHWs) excel. When CHWs are adequately trained, supervised, supported, and compensated, they can improve health outcomes, lower costs, reduce inequities, and strengthen health systems.
Authors
- Daniel Palazuelos (ORCID: https://orcid.org/0000-0003-3701-0707)
- Kelsey Vaughan (ORCID: https://orcid.org/0009-0002-0603-7368)
- Joy Swanson Ernst (ORCID: https://orcid.org/0009-0003-3416-9154)
- Soleine Scotney
- Harriet G. Napier (ORCID: https://orcid.org/0000-0001-8788-6796)
- James O’Donovan (ORCID: https://orcid.org/0000-0002-7248-5436)
- Linnea Stansert Katzen (ORCID: https://orcid.org/0000-0002-9864-6488)
- Madeleine Ballard (ORCID: https://orcid.org/0000-0003-0107-4047)
- Dickson Mbewe
- Carey Westgate (ORCID: https://orcid.org/0000-0003-4435-1286)
- Cleo Baskin (ORCID: https://orcid.org/0000-0001-6254-8707)
- Zeus Aranda (ORCID: https://orcid.org/0000-0001-5272-1967)
- Shivani Shukla (ORCID: https://orcid.org/0000-0001-9706-311X)
- Marius Nkenfack
- Madelyn Miyares (ORCID: https://orcid.org/0009-0004-8293-505X)
Institutions
- University of North Carolina at Chapel Hill (US)
- Uppsala University (SE)
- Brigham and Women's Hospital (US)
- Partners In Health (US)
- Harvard University (US)
- Stellenbosch University (ZA)
- Partners for Health and Development in Africa (KE)
- Clinton Health Access Initiative (US)
- Mali-Folkecenter (ML)
- Community Impact (US)
- Harvard Global Health Institute (US)
- Fundação Oswaldo Cruz (BR)
- Icahn School of Medicine at Mount Sinai (US)
Publication Details
- Journal
- The Lancet Primary Care
- Published
- 2025-11-29
- DOI
- https://doi.org/10.1016/j.lanprc.2025.100076
- Primary Topic
- Global Maternal and Child Health
- Type
- article
- Field-Weighted Citation Impact
- 0.00