Work

Valuing community health workers (CHWs): Opportunity costs and out-of-pocket spending among CHWs in the Indonesian stunting prevention program

Year: 2025

Type: article

Abstract: Introduction In the Indonesian stunting prevention program, the often non-salaried community health workers (CHWs) are responsible for monthly monitoring, counseling, and home visits. Understanding the importance of their roles from an economic perspective may inform a more sustainable and improved program delivery. Aim To estimate the opportunity costs and out-of-pocket spending incurred by the CHWs in the Indonesian stunting prevention program. Methods This cross-sectional study was conducted in two rural villages in Lombok, Indonesia. We interviewed 130 CHWs with a pre-validated, structured questionnaire. Opportunity costs were assessed using two valuation models: calculating their working time valuation based on regional minimum wage and the CHWs' self-reported earnings outside of their community health work. Results We found that 52·31 % of the CHWs were not satisfied with the current incentivization scheme. Opportunity cost calculation shows that these CHWs were underpaid: reported monthly workload is valued at USD 46·54 according to the valuation model based on regional minimum wage and USD 13·81 based on CHWs self-reported income. Furthermore, out-of-pocket spending reached almost one-third of the received incentives (median USD 2.90 (IQR 0·87–4·95)). Conclusion Appropriately incentivizing CHWs working on stunting prevention programs in Indonesia is one of the main priorities to ensure better program delivery.

Source: Clinical Epidemiology and Global Health

DOI: 10.1016/j.cegh.2025.101982