What a decade of economic evidence means for professional community health workers
When Liberia shifted from fragmented disease-specific programs to CHW-led integrated care, the cost of treating neglected tropical diseases dropped by up to tenfold. At the same time, far more people were reached. Same health system. Same diseases. Different design. Dramatically different result.
This is what happens when CHWs are properly supported—and the evidence is now irrefutable.
Community Health Impact Coalition (CHIC) has built the most comprehensive global evidence base on community health worker programs to date through a landmark series of five scoping reviews, plus a one-page synthesis designed for policy impact. We systematically identified and analyzed every single piece of economic evidence from the last decade—255 studies covering 380 CHW program scenarios across different disease areas, countries, and methodologies.
For years, economic evidence on CHWs has been fragmented. Research showed that CHWs delivered strong outcomes at reasonable cost, but the evidence rarely answered the questions governments and funders needed to make sustained investment decisions.
Now it does.
Design determines results
The evidence defends something the proCHW movement has long known. Not all CHW programs are created equal.
Cost-effectiveness does not come from community delivery alone. It is produced through design. Across the evidence, integration is the multiplier.
When CHWs are salaried, trained to deliver care across conditions, and linked to facilities and referral systems, they do not just match alternative delivery models. They outperform them—delivering stronger health outcomes, wider coverage, and better value for every dollar spent.
