Table 3.

Recommendations for future research

To provide decision makers with adequate and useful data on the cost effectiveness of lay health worker interventions for vaccination, future evaluations of such programmes should:
Compare the costs of alternative options	• include a comparative analysis of costs and consequences of alternative courses of action, or at least a detailed costing of personnel and other resources associated with the intervention
Standardize design, analysis and reporting	• address the current lack of standardization in the design, analysis and reporting of economic evaluations results; in the range of outcomes used; and in the reporting of contextual factors, to improve the comparability of these evaluations
Examine the variability of interventions	• look explicitly at variability between interventions implemented in different locations (within or between countries) and explore how different levels of resources contribute to different levels and combinations of outcomes
Explore types and levels of remuneration	• explore how different levels and methods of remuneration, and types of financial or non-financial incentives, impact on the cost-effectiveness and sustainability of programmes
Vary the evaluation time frame	• explore the impacts on cost-effectiveness of incorporating a longer evaluation time-frame
Capture the instrumental value of LHWs to the communities in which they work*	• assess the impact on cost-effectiveness of using an institutional economics framework, such addressing issues of implicit contracts and informational asymmetries; taking into account governance issues and institutional evolution and transition; and conducting a transaction cost analysis •develop approaches to account for volunteer labour in these programmes

* Jan S, Pronyk P, Kim J: Accounting for institutional change in health economic evaluation: a program to tackle HIV/AIDS and gender violence in Southern Africa. Soc Sci Med 2008, 66:922-932.