The cost-effectiveness of community health workers in primary health care: a systematic review.

Abstract

Background: Global interest in community health worker (CHW) programs in primary health care (PHC) is rising due to their potential to advance universal health coverage and other global health goals. This systematic review examines the evidence on the cost-effectiveness of CHW interventions worldwide, with a focus on vulnerable populations in PHC settings.

Methods: A systematic review was conducted using the PubMed, Embase, Web of Science Core Collection, SCOPUS and EconLit databases. The search was last updated on May 13, 2025. Two reviewers independently selected articles, rated their quality and extracted relevant data. Included articles had to be full economic evaluations comparing CHW interventions to usual care without CHWs, focussing on vulnerable populations in PHC. A standardized data extraction template was used and the reporting quality was assessed using the CHEERS checklist.

Results: Fifty articles were included, originating from 25 countries. All but one of the economic evaluations were disease-specific, focusing mainly on maternal, newborn and child health, type 2 diabetes mellitus, tuberculosis, cardiovascular disease, mental health, and HIV. Most articles (n = 35, 70%) indicated that CHW interventions were (potentially) cost-effective. Fourteen out of these 35 articles can substantiate their findings with a probabilistic sensitivity analysis (PSA).

Conclusion: This review found that CHWs can be cost-effective across multiple health domains, both in LMICs and HICs. The lack of PSA, together with heterogeneity in contexts, interventions and methods used to assess the cost-effectiveness of the CHW interventions makes it difficult to draw general conclusions about the value-for-money of CHWs in PHC.