Healthcare service delivery interventions in low- and middle-income countries: cost effectiveness

Added November 16, 2021

Citation: Watson SI, Sahota H, Taylor CA, et al. Cost-effectiveness of health care service delivery interventions in low and middle income countries: A systematic review. Global Health Research and Policy. 2018;3:17.

Language: Abstract and full text only available in EN.

Free to view: Yes.

Funding sources: UK National Institute for Health Research (NIHR) using Official Development Assistance (ODA).

What is this? Low- and middle-income countries (LMICs) have limited resources and face a high disease burden. Cost-effective interventions may lead to a better provision of services for various conditions and a more resilient health system.

In this systematic review, the authors searched for studies of economic evaluations of healthcare service delivery interventions in LMICs. They did not restrict their searches by language of publication and searched for articles published between January 2000 and October 2016. They included 36 studies, which were from Bangladesh (1), Brazil (1), China (1), Côte d’Ivoire (1), Ethiopia (1), Ghana (1), India (4), Kenya (4), Nicaragua (2), Pakistan (2), Sierra Leone (1), South Africa (7), Thailand (1), Uganda (6) and Zambia (2). There was also a review that included studies from 70 countries.

What was found: Shifting tasks from doctors to nurses or community health workers, or from facilities into the community, was cost effective.

HIV management and counselling at home was more effective than the same service provision in facilities but was more costly.

Involving and training community members in emergency care, cardiovascular disease management, and mental health were cost effective.

Quality improvement efforts in the community that involved training staff, equipment upgrades and better surveillance were cost effective.

Implications: The authors of the review stated that decision makers will have difficulty choosing between alternative organizational arrangements if knowledge on their relative cost effectiveness is limited. They also stated that standardization of research methods and reporting of economic evaluations in this context is essential for future research and guidelines.

Other considerations: The authors of the review discussed their findings in the context of place of residence.


This summary was prepared by Yasmeen Saeed, edited by Firas Khalid and Jiewon Lim, and finalized by Mike Clarke.

Disclaimer: This summary has been written by staff and volunteers of Evidence Aid in order to make the content of the original document accessible to decision makers who are searching for the available evidence on humanitarian response but may not have the time, initially, to read the report in full. This summary is not intended as a substitute for the medical advice of physicians, other health workers, professional associations, guideline developers, or national governments and international agencies. If readers of this summary think that the evidence presented within it is relevant to their decision-making, they should refer to the content and details of the original article, and the advice and guidelines offered by other sources of expertise, before making decisions. The text can be shared and re-used without charge, citing Evidence Aid as the source and noting the date on which you took the text.