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Clin Infect Dis. 2019 Apr 24;68(9):1588-1595. doi: 10.1093/cid/ciy741.

Valuing the Unpaid Contribution of Community Health Volunteers to Mass Drug Administration Programs.

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Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam.
Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford.
London Centre for Neglected Tropical Disease Research, School of Public Health, Faculty of Medicine, St Marys Campus, Imperial College London.
Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Marys Campus, Imperial College London.
Independent Consultant, Gravesend, Kent, United Kingdom.
Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Department of Health Administration and Management, University of Nigeria Enugu Campus.
Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria.
Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland.


Community health volunteers (CHVs) are being used within a growing number of healthcare interventions, and they have become a cornerstone for the delivery of mass drug administration within many neglected tropical disease control programs. However, a greater understanding of the methods used to value the unpaid time CHVs contribute to healthcare programs is needed. We outline the two main approaches used to value CHVs' unpaid time (the opportunity cost and the replacement cost approaches). We found that for mass drug administration programs the estimates of the economic costs relating to the CHVs' unpaid time can be significant, with the averages of the different studies varying between US$0.05 and $0.16 per treatment. We estimated that the time donated by CHVs' to the African Programme for Onchocerciasis Control alone would be valued between US$60 and $90 million. There is a need for greater transparency and consistency in the methods used to value CHVs' unpaid time.


APOC; community volunteers; economic costs; mass drug administration; unpaid work

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