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Program spending to increase adherence: South African cervical cancer screening
Jeremy D Goldhaber-Fiebert1, Lynette A Denny, Michelle De Souza
1Program in Health Decision Science, Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, United States of America. jeremygf@stanford.edu
Plos One
|June 4, 2009
Summary
Investing in community health worker (CHW) home visits significantly boosts attendance for cervical cancer screening. Increased CHW visits led to higher adherence rates, demonstrating a cost-effective strategy for public health programs.
Area of Science:
- Public Health
- Health Economics
- Preventive Medicine
Background:
- Adherence to public health programs is vital for effectiveness.
- Balancing program benefits against costs is essential.
- Community health worker (CHW) home visits are a key intervention.
Purpose of the Study:
- To examine the link between CHW home visit investment and cervical cancer screening attendance.
- To quantify the impact of CHW interventions on adherence rates.
- To inform program planning and resource allocation.
Main Methods:
- Observational study of 5,258 CHW home visits in Cape Town, South Africa (2003-4).
- Analysis of the relationship between CHW spending and appointment adherence.
- Cost analysis based on personnel time and vehicle expenses.
Main Results:
- Each additional CHW visit increased appointment adherence.
- Adherence rates rose significantly across 6-, 12-, 24-, and 36-month appointments.
- The majority of adherence gains occurred with the first two CHW visits, at a modest cost increase.
Conclusions:
- Study data aids in program planning and achieving adherence targets within budgets.
- CHW home visits represent a cost-effective method to improve screening attendance.
- Results from this cervical cancer screening program require prospective validation.
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