Discussion
diarrhoea, low disability, fever, ’, malaria, infections, respiratory diseases
MALARIA, RESPIRATORY DISEASE, DISEASE, INFECTIONS
In the cost-effectiveness analysis, specific CETs were applied to determine economic feasibility. The probability of satisfying the conservative first and second CETs was very low. However, there was a high possibility of satisfying the third to fifth CETs, which are commonly used. On the other hand, economic feasibility was consistently achieved in the cost-benefit analysis. In most probability samples, the cost-benefit ratio was greater than 1, and there was a high probability of the cost-benefit ratio exceeding 3. Even in the most pessimistic sensitivity analysis scenario, there was also a high probability that the cost-benefit ratio would be more than 1.Previous research has shown that home visits for CHWs are affordable in low- and middle-income countries, saving the lives of newborns, lowering the incidence of HIV, and increasing exclusive breastfeeding [Nevertheless, this study has clear implications. First, CHVs’ home visits conducted solely to prevent childhood disease through behaviour change are not economically feasible within Ghana’s health system. Therefore, it seems that CHVs’ home visits should be combined with tasks whose economic feasibility has been verified. According to a previous field-based economic evaluation conducted in Ghana, CHVs’ intensive home visits after childbirth for newborn survival were economically feasible [Second, this study implies that in health systems like that of Ghana, where dual cadres of CHWs are operated, CHVs’ role in conducting effective home visits may have an indirect effect on reducing the burdens of CHOs. This demonstrates that CHVs are not a replaceable measure of CHOs; instead, they constitute a sustainable health workforce that works in harmony with CHOs. According to Ghana’s health policy, two CHOs should be deployed per CHPS zone, but in fact, only one CHO is working in 44% of CHPS zones [These first and second implications could both assist in evidence-based policy-making that defines the optimal work scope of the dual cadres of CHWs in Ghana’s health system. This study also has implications for the global health community. To integrate CHW programmes with national health systems, we need to find the most effective scope of work for CHWs within national health systems. To this end, more economic evaluations of field experiment based CHW programmes need to be carried out. Ethiopia, for example, operates dual cadres of CHWs within its national health system (health extension workers and the Women’s Development Army), similar to the CHVs and CHOs of Ghana. Our study may provide ideas for future studies to specify the optimal scope of work for the dual cadres of CHWs in the Ethiopian setting.This study has three main limitations. First, since this study used a probabilistic approach to cost-effectiveness and cost-benefit using Bayesian inference with weak prior information, the study’s results should not be interpreted as deterministic conclusions. Second, although this study used period prevalence as a proxy measure of incidence, there may be differences from the actual incidence in the population because the duration of diarrhoea and malaria onset is shorter than the longitudinal panel survey cycle. Third, using high fever as a proxy measure for malaria may overestimate the amount of DALYs, because high fever may be associated with other infections with low disability weights, such as respiratory diseases.