Valuing community health workers (CHWs): Opportunity costs and out-of-pocket spending among CHWs in the Indonesian stunting prevention program

IF 2.3 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health Pub Date : 2025-03-26 DOI:10.1016/j.cegh.2025.101982

Adriana Viola Miranda , Ryan Rachmad Nugraha , Trio Sirmareza , Maritta Rastuti , Rizky Deco Praha , Rindang Asmara , Zack Petersen

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引用次数: 0

Abstract

Introduction

In the Indonesian stunting prevention program, the often non-salaried community health workers (CHWs) are responsible for monthly monitoring, counseling, and home visits. Understanding the importance of their roles from an economic perspective may inform a more sustainable and improved program delivery.

Aim

To estimate the opportunity costs and out-of-pocket spending incurred by the CHWs in the Indonesian stunting prevention program.

Methods

This cross-sectional study was conducted in two rural villages in Lombok, Indonesia. We interviewed 130 CHWs with a pre-validated, structured questionnaire. Opportunity costs were assessed using two valuation models: calculating their working time valuation based on regional minimum wage and the CHWs’ self-reported earnings outside of their community health work.

Results

We found that 52·31 % of the CHWs were not satisfied with the current incentivization scheme. Opportunity cost calculation shows that these CHWs were underpaid: reported monthly workload is valued at USD 46·54 according to the valuation model based on regional minimum wage and USD 13·81 based on CHWs self-reported income. Furthermore, out-of-pocket spending reached almost one-third of the received incentives (median USD 2.90 (IQR 0·87–4·95)).

Conclusion

Appropriately incentivizing CHWs working on stunting prevention programs in Indonesia is one of the main priorities to ensure better program delivery.

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导言在印度尼西亚的发育迟缓预防项目中，社区保健员（CHWs）通常不领取工资，他们负责每月的监测、咨询和家访。目的对印度尼西亚发育迟缓预防项目中社区保健员的机会成本和自费支出进行估算。方法这项横断面研究在印度尼西亚龙目岛的两个农村进行。我们使用事先经过验证的结构化问卷对 130 名儿童保健工作者进行了访谈。我们使用两种估价模型对机会成本进行了评估：根据地区最低工资计算他们的工作时间估价，以及社区保健员自我报告的社区保健工作以外的收入。机会成本计算显示，这些社区保健员的报酬偏低：根据基于地区最低工资的估价模型，报告的月工作量价值为 46-54 美元，而根据社区保健员自我报告的收入，则为 13-81 美元。此外，自费支出几乎达到所获奖励的三分之一（中位数为 2.90 美元（IQR 为 0-87-4-95 美元））。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Epidemiology and Global Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

4.60

自引率

7.70%

发文量

218

审稿时长

66 days

期刊介绍： Clinical Epidemiology and Global Health (CEGH) is a multidisciplinary journal and it is published four times (March, June, September, December) a year. The mandate of CEGH is to promote articles on clinical epidemiology with focus on developing countries in the context of global health. We also accept articles from other countries. It publishes original research work across all disciplines of medicine and allied sciences, related to clinical epidemiology and global health. The journal publishes Original articles, Review articles, Evidence Summaries, Letters to the Editor. All articles published in CEGH are peer-reviewed and published online for immediate access and citation.