Economic Valuations on Village Health Worker’ Recompense in Lesotho

Presenter: Feng Zhao, The World Bank

Abstract

It is well recognized that community-based health interventions are essential for achieving better health outcomes. The Declaration of Alma Alta in 1978 and the subsequent Ottawa Charter formally acknowledged community-based health interventions as an integral part of primary health care. In Lesotho, community-based health interventions are normally delivered by a combination of health professionals and Village Health Worker (VHW). Most recently Lesotho Government decided to pay their VHW about 300 Maloti per month. This financing policy demonstrated the commitment of Lesotho Government to the health human resource development and to the improvement of accessing basic health service for all. However, there is no evidence to show this amount of payment reflects the value of VHW’s work and what this amount paid for. The objective of this report mainly focuses on the issue of the economic valuation of VHW recompense, which directly related to the sustainability of VHW in the remote areas. In addition, current VHW’s workload and responsibility have been also investigated in this study.

The valuation of VHWs’ work by community member and willingness to accept (WTA) by VHW to work in their local community have been investigated in this study. In addition, the background and validity-checking questions have been included in the questionnaires. Cluster sampling method has been used for the selection of VHWs. Cluster plus systematic sampling methods have been applied to select local community members. A total of 174 VHWs and 300 Community Members participated in this study. The descriptive statistic methods are used of the data analysis. Tobit model has been used to identify the factors that affect VHWs value from community members and WTA from VHW.

The results displayed that VHW is playing very important role in ensuring the health of the population in their community. Although there are some discrepancies between the community members and VHWs in terms of VHW functions, the community members highly value VHW’s services and very satisfy their roles in the community. Although VHW is considered as a volunteer, their service is not free. Each household spend about 64 Maloti on VHW service per year. The average age of current VHW is about 53 years old. The average initial training is about 3 weeks. Each VHW received 5 times additional training after the pre-service training in the past three years. VHW has about 13 years working experiences as VHW after their pre-service training. They spent about 4.5 hours per day engaged in seeing patients; and the average number of patients they have encountered is about 3-4 patients per day. They spend about15 days per month working as a VHW. The result from community member’s survey displayed that the payment to VHW should be about 541 Maloti per month and the result from VHWs survey displayed that the payment to VHW should be about 712 Maloti, both them are significantly higher than the current government payment to VHW.

Authors: Feng Zhao, Hong Wang, Nora Groce, Kanako Yamashita-Allen

Session: Economic Evaluation
Time: Wed 11:15 a.m.-12:15 p.m.
Room: 305B