Valuing community health workers (CHWs): Opportunity costs and out-of-pocket spending among CHWs in the Indonesian stunting prevention program
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...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-05-01
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| Series: | Clinical Epidemiology and Global Health |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2213398425000715 |
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| author | Adriana Viola Miranda Ryan Rachmad Nugraha Trio Sirmareza Maritta Rastuti Rizky Deco Praha Rindang Asmara Zack Petersen |
| author_facet | Adriana Viola Miranda Ryan Rachmad Nugraha Trio Sirmareza Maritta Rastuti Rizky Deco Praha Rindang Asmara Zack Petersen |
| author_sort | Adriana Viola Miranda |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-66ef1eab09e748bfbe1e141b3ef2fc30 |
| institution | OA Journals |
| issn | 2213-3984 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Clinical Epidemiology and Global Health |
| spelling | doaj-art-66ef1eab09e748bfbe1e141b3ef2fc302025-08-20T02:26:51ZengElsevierClinical Epidemiology and Global Health2213-39842025-05-013310198210.1016/j.cegh.2025.101982Valuing community health workers (CHWs): Opportunity costs and out-of-pocket spending among CHWs in the Indonesian stunting prevention programAdriana Viola Miranda0Ryan Rachmad Nugraha1Trio Sirmareza2Maritta Rastuti3Rizky Deco Praha4Rindang Asmara5Zack Petersen61000 Days Fund, Jakarta, Indonesia; Corresponding author. 1000 Days Fund, Indonesia.Dept. of Family and Community Medicine, University of Gadjah Mada, Yogyakarta, Indonesia1000 Days Fund, Jakarta, Indonesia1000 Days Fund, Jakarta, Indonesia1000 Days Fund, Jakarta, Indonesia1000 Days Fund, Jakarta, Indonesia1000 Days Fund, Jakarta, IndonesiaIntroduction: 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.http://www.sciencedirect.com/science/article/pii/S2213398425000715Community health workersStuntingOpportunity cost |
| spellingShingle | Adriana Viola Miranda Ryan Rachmad Nugraha Trio Sirmareza Maritta Rastuti Rizky Deco Praha Rindang Asmara Zack Petersen Valuing community health workers (CHWs): Opportunity costs and out-of-pocket spending among CHWs in the Indonesian stunting prevention program Clinical Epidemiology and Global Health Community health workers Stunting Opportunity cost |
| title | Valuing community health workers (CHWs): Opportunity costs and out-of-pocket spending among CHWs in the Indonesian stunting prevention program |
| title_full | Valuing community health workers (CHWs): Opportunity costs and out-of-pocket spending among CHWs in the Indonesian stunting prevention program |
| title_fullStr | Valuing community health workers (CHWs): Opportunity costs and out-of-pocket spending among CHWs in the Indonesian stunting prevention program |
| title_full_unstemmed | Valuing community health workers (CHWs): Opportunity costs and out-of-pocket spending among CHWs in the Indonesian stunting prevention program |
| title_short | Valuing community health workers (CHWs): Opportunity costs and out-of-pocket spending among CHWs in the Indonesian stunting prevention program |
| title_sort | valuing community health workers chws opportunity costs and out of pocket spending among chws in the indonesian stunting prevention program |
| topic | Community health workers Stunting Opportunity cost |
| url | http://www.sciencedirect.com/science/article/pii/S2213398425000715 |
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