The High Cost of Free

Relying on community health workers (CHWs, local people trained for basic health promotion and care delivery) in low- and middle-income countries seems like a no-brainer. It’s been a mainstay of global health for decades.

But, writes Sebastian Bauhoff, “the full costs remain murky and are often an afterthought.”  Since many CHWs aren’t paid, it’s hard to say if the programs that use them are cost effective. A couple reports estimate that less than 10% of CHWs in Africa are paid.

The danger is that using CHWs can undermine government’s incentives to train and employ paid health workers, not to mention the fact that the practice is unfair to individuals doing important work for free.
Center for Global Development

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