The Costs of Volunteering: Quantifying the Economic Value of Community Resources Contributed to an Integrated Neglected Tropical Disease Control Program in Nigeria Open Access
Jaszi, Edward (2013)
Published
Abstract
Background/Objective
Neglected tropical disease (NTD) control programs in Africa
typically rely on community volunteers to carry out drug
distribution and other essential tasks. Although the benefits of
using volunteer labor have been demonstrated from a programmatic
perspective, little is known about the costs that are imposed on
volunteers themselves. This research aimed to quantify the
financial and opportunity costs incurred by community volunteers
contributing to the Carter Center-supported NTD program in north
central Nigeria between 2009 and 2010.
Methodology/Principal Findings
Retrospective data on inputs were collected from a sample of
community-directed distributors (CDDs) and village heads (VHs)
using a survey instrument. Programmatic data were used to make
inferences about the study population. While performing NTD
activities each year, the average CDD worked 15.5 days and incurred
financial costs of $5.36 (USD, 2010), while the average VH worked 5
days and had costs of $4.09. When volunteer time was valued in
monetary units and combined with financial costs, the total value
of resources contributed was estimated at $.06 per treatment
distributed and $72.60 per community. For opportunity costs related
to NTD activities, a downward trend was observed between study
years. However, when inputs to insecticide-treated bed net (ITN)
distribution in 2010 were included, this trend was reversed due to
significantly higher costs among those distributing ITNs. The sum
total of economic costs incurred by communities in the study area
was estimated at $259,630 per year for NTD activities, and $337,527
for NTD and ITN activities combined in 2010.
Conclusion
This study finds that significant and wide-ranging economic costs
were imposed on community members contributing to an NTD program.
CDDs in particular bore the brunt of these economic costs, although
community support played a role in redistributing them more
broadly. The data suggest that while integration of preexisting
interventions may have contributed to modest reductions in
communities' economic costs, the addition of a new intervention led
to substantial cost increases. Overall, the findings raise concerns
about whether integrated NTD programs can sustainably expand the
scale and scope of their services without providing commensurate
incentives to CDDs.
Table of Contents
Chapter 1: Introduction................................................................................................................ 1
Introduction/Rationale................................................................................................................. 1
Problem Statement....................................................................................................................... 4
Purpose........................................................................................................................................ 6
Research Goals............................................................................................................................ 6
Significance.................................................................................................................................. 7
Definition of Terms..................................................................................................................... 7
Chapter 2: Comprehensive Review of the Literature............................................................... 9
Background.................................................................................................................................. 9
Description of CHWs.............................................................................................................. 9
Global distribution and characteristics of CHWs.................................................................. 10
Use of CHWs by multiple programs..................................................................................... 11
Integration of NTD programs................................................................................................ 12
Results of Integration............................................................................................................ 13
Financing................................................................................................................................ 14
Incentives and Community Financing in NTD MDA Programs........................................... 16
Motivation and Performance................................................................................................. 19
Methods for the economic evaluation of CHW programs......................................................... 21
Economic evaluations in health care...................................................................................... 21
Transfers................................................................................................................................ 22
Cost distribution.................................................................................................................... 23
Community economic costs.................................................................................................. 23
Valuation of donated goods................................................................................................... 23
Valuation of paid labor.......................................................................................................... 24
Valuation of volunteer labor.................................................................................................. 24
Economic evaluations of CHW programs in the literature........................................................ 27
Overview............................................................................................................................... 27
Economic evaluations of CHW programs in higher income countries................................... 28
Economic evaluations of TB programs using CHWs............................................................ 28
Economic evaluations of child survival interventions using CHWs...................................... 30
Economic evaluations of MDA interventions utilizing CHWs............................................. 31
Other relevant economic evaluations..................................................................................... 33
Conclusion................................................................................................................................. 34
Chapter 3: Methodology............................................................................................................. 35
Introduction............................................................................................................................... 35
Research Design......................................................................................................................... 35
Study Setting............................................................................................................................. 35
Population and Sample.............................................................................................................. 36
Instruments................................................................................................................................ 36
Data entry and analysis............................................................................................................. 37
Valuation of Time Inputs.......................................................................................................... 39
Limitations and Delimitations................................................................................................... 40
Chapter 4: Results...................................................................................................................... 41
Summary of Programmatic Data................................................................................................ 41
Respondent Characteristics....................................................................................................... 44
Time Inputs for NTD Activities............................................................................................... 44
Time Inputs by NTD Programmatic Activity.......................................................................... 48
Comparison of Time Inputs for Integrated and Non-Integrated NTD Treatment.................... 49
Costs and Transfers: Financial and In-Kind.............................................................................. 50
Inputs per NTD Treatments Distributed in the Study Population.......................................... 52
Inputs for ITN Distribution...................................................................................................... 54
Total Value of Economic Costs................................................................................................. 56
Chapter 5...................................................................................................................................... 59
Discussion................................................................................................................................. 59
Areas of further study............................................................................................................... 62
Recommendations...................................................................................................................... 64
Conclusion................................................................................................................................. 65
References...................................................................................................................................... 66
Appendices..................................................................................................................................... 70
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