Impact of dropout of female volunteer community health workers: an exploration in Dhaka urban slums

Khurshid Alam, Jahangir AM Khan, Damian G Walker

Research output: Contribution to journalArticleResearchpeer-review

13 Citations (Scopus)


The model of volunteer community health workers (CHWs) is a common approach to serving thepoor communities in developing countries. BRAC, a large NGO in Bangladesh, is a pioneer in this area, hasbeen using female CHWs as core workers in its community-based health programs since 1977. After 25 years ofimplementing of the CHW model in rural areas, BRAC has begun using female CHWs in urban slums through acommunity-based maternal health intervention. However, BRAC experiences high dropout rates among CHWssuggesting a need to better understand the impact of their dropout which would help to reduce dropout andincrease program sustainability. The main objective of the study was to estimate impact of dropout ofvolunteer CHWs from both BRAC and community perspectives. Also, we estimated cost of possible strategies toreduce dropout and compared whether these costs were more or less than the costs borne by BRAC and thecommunity.Methods: We used the ingredient approach to estimate the cost of recruiting and training of CHWs andthe so-called friction cost approach to estimate the cost of replacement of CHWs after adapting. Finally, weestimated forgone services in the community due to CHW dropout applying the concept of the friction period.Results: In 2009, average cost per regular CHW was US 59.28 which was US 60.04 for an ad-hoc CHW if aCHW participated a three-week basic training, a one-day refresher training, one incentive day and worked for amonth in the community after recruitment. One month absence of a CHW with standard performance in thecommunity meant substantial forgone health services like health education, antenatal visits, deliveries, referralsof complicated cases, and distribution of drugs and health commodities. However, with an additionalinvestment of US 121 yearly per CHW BRAC could save another US 60 invested an ad-hoc CHW plus forgoneservices in the community.Conclusion: Although CHWs work as volunteers in Dhaka urban slums impact of their drop
Original languageEnglish
Pages (from-to)1 - 9
Number of pages9
JournalBMC Health Services Research
Issue numberArt. ID: 260
Publication statusPublished - 2012

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