Evaluating the effect of village health workers on hospital admission rates and their economic impact in the Kingdom of
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RESEARCH ARTICLE
Open Access
Evaluating the effect of village health workers on hospital admission rates and their economic impact in the Kingdom of Bhutan Sacha C. Hauc1*† , Dolley Tshering2†, Josemari Feliciano1, Agata M. P. Atayde3, Layla M. Aboukhater3, Kinley Dorjee2, Tshering Dukpa4, Pema Rinchen4, Neema Yoezer4, Casey M. Luc1, Rup N. Adhikari2, Kezang Lhamo2 and Kaveh Khoshnood1
Abstract Background: Village health workers (VHWs) in Bhutan play an all-encompassing role in supporting the health of their communities. Recent reports from the Bhutan Ministry of Health have indicated a sharp reduction in the number of working VHWs. As such, our work attempts to estimate the cost saved and the number of averted hospital admissions onto the Bhutanese healthcare system and the individuals who are served by these health workers. Methods: We utilized a dataset from the Bhutan Ministry of Health which encompassed over 95% of all reported disease cases within the nation. We examined the impact that VHWs have on hospital admission rates for eight diseases of interest by using multiple multivariate logistic regression models. Our model allowed us to estimate the potential disease cases averted when the average number of VHWs per health center is increased by one unit. Lastly, we utilized the 2011 “A Costing of Healthcare Services in Bhutan” to estimate the cost saved attributed to VHWs. Results: An average one unit increase of VHWs per health center is associated with a decrease in hospital and clinic admission for diarrhea, dysentery, wound care, depression/anxiety, dental caries, and skin infection, while a non-significant increase was observed for scabies and conjunctivitis. These findings translate to 4604 outpatient visits averted, with $28,637 saved, and 78 inpatient visits averted, with $10,711 saved. These values sum to a total of 4682 yearly averted admissions at health centers, with a total cost savings of $39,348 yearly. Additionally, we estimated a yearly savings of $13,348 in transportation costs and a total of $20,960 saved in wages to the community members that VHWs serve. (Continued on next page)
* Correspondence: [email protected] † Sacha C. Hauc and Dolley Tshering contributed equally to this work. 1 Yale University School of Public Health, Laboratory of Epidemiology and Public Health, 60 College St, New Haven, CT 06510, USA Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Common
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