Evaluating the effect of village health workers on hospital admission rates and their economic impact in the Kingdom of Bhutan

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. Conclusions VHWs serve as a source of cost-savings for the Kingdom of Bhutan and also act as an economic buffer for more vulnerable communities. The cost-savings associated with these health workers is likely to become more pertinent as the nation begins to develop and healthcare costs increase. It is imperative that proper action be taken to retain these health workers as every VHW who leaves the program increases healthcare costs onto the Bhutanese government.

Empirical Evidence of the Livelihood Vulnerability to Climate Change Impacts: A Case of Potato-Based Mountain Farming Systems in Bhutan

“…Likewise, immunization coverage was as high as 95% in 2010. Such substantial health achievements are, at least, partly attributable to the 'one village health worker per each health center' initiative put in place at the grassroots level by the Royal Government of Bhutan [86]. Moreover, all the health services are state funded and provided for free, as guaranteed in the constitution of Bhutan.…”

Scoping Review to Identify Potential Solutions to Challenges Faced by Village Health Workers in Bhutan

“…Using prior research from our team, we reveal that there is a clear economic argument for investing in the VHWs program as well as expanding training and programing based on the urban-rural divide. 5 The role of CHWs in developing nations can be as straightforward as dispensing basic medications or as involved as providing mental health counseling for vulnerable communities. 6 It is essential to note, that the level of participation of CHWs within their communities is entirely based on the institutions and governments which back them.…”

“…Lastly, in previous research, data from over 95% of all reported disease admissions within Bhutan were used to model the cost-savings associated with VHWs. 5 . These findings demonstrated that for every VHW that was added to Bhutan not only were their costs saved for the healthcare system, but also hospital admissions were averted, and money was saved in the form of lost wages and transportation.…”