A World Health Organization report from December 2017 found that at least half of the world’s population still lacks access to essential health services. This situation has worsened since the onset of the COVID-19 pandemic as resources have been diverted, people have become fearful to seek care, and consequent economic crises have made it more difficult to pay for services.
At the end of 2021, 92% of countries reported disruptions in at least one essential health service in WHO Global Pulse Surveys. Compounding these problems, the world is facing a shortage of 15 million health workers, according to WHO.
If we do not urgently address these challenges, global health gains made over the past two decades, such as reductions in maternal and child mortality and increases in life expectancy, could be lost.
The potential and unrecognized value of community health workers
Community health workers, or CHWs, have a key role to play. These trusted community members connect their peers to health and social resources and extend health care services to under-resourced populations. They serve the daily health needs of their neighbors by delivering an integrated package of lifesaving care, including disease surveillance, and essential maternal and child health services. Our organizations witness their impact every single day.
Research from Last Mile Health shows that CHWs in Liberia have significantly increased access to care for children ill with malaria, diarrhea, and respiratory infections and have helped increase facility-based childbirth by over 25%. CHWs in Liberia now treat 45% of all malaria cases for children under 5.
Research from the Community Health Impact Coalition has proven, for the first time, that these trends are maintained in times of instability — professional CHWs who were equipped and prepared for the COVID-19 pandemic were able to maintain care for over five million people across four countries through multiple waves of infection over two years.
Despite their proven impact, CHWs are still undervalued. In Africa, only 14% of CHWs are paid for their work, contrary to WHO guidelines. They are also stretched thin — according to the Community Health Impact Coalition, just 916,000 CHWs in sub-Saharan Africa serve over 400 million people.
CHWs are positioned to provide health coverage to millions of people around the world, but they must be properly equipped to do so. This new research suggests the opportunity cost of this underinvestment is larger than previously estimated.
Innovation to expand reach and impact
While growing up in rural Ethiopia, Workinesh Getachew recalls CHWs visiting her village, going door to door, meeting neighbors, checking on the sick, and providing care. “The care they give and the acceptance among the community have been continuous motivation for me,” she said.
By creating and utilizing personal bonds, these regular visits helped forge connections between her community and the larger health system and helped keep her family and neighbors healthy. That motivated Getachew to become a CHW herself. She now works for Ethiopia’s pioneering health extension worker program, providing screening for malnutrition, assisting with vaccination campaigns, conducting postnatal care visits, educating community members about better sanitation practices, and more. Getachew is one of more than 40,000 CHWs who are trained, paid, and equipped by Ethiopia’s Ministry of Health.
Providing ongoing skills training for CHWs is essential and must be incorporated into national health budgets. Getachew recently participated in an innovative program developed by Last Mile Health and the Ethiopia Ministry of Health that blends in-person and digital training for a fraction of the cost of the traditional approach. Innovations such as the Extension Essentials program can put better quality care within reach for millions of people in hard-to-reach communities.
Another example of an innovative solution magnifying the impact of CHWs is reach52’s offline-first tech platform. Many areas where CHWs are essential have low levels of internet connectivity. reach52’s platform allows CHWs to collect data anywhere and sync back to the cloud when a connection is available, providing critical insights and tools to support the design, implementation, and monitoring of community-level campaigns. Through the platform, targeted interventions are delivered to the cohort of residents filtered from data collected, with CHWs compensated per engagement in addition to the wages they receive as public sector employees.
Investment as a catalyst
While the value of a community health workforce is undisputed, few CHW programs are set up to reach the scale necessary to succeed at a national level. More investments are desperately needed to make sure CHWs are paid, trained, equipped, and integrated into strong national community health systems.
Recent investments by the Johnson & Johnson Foundation and the Skoll Foundation in the Global Fund’s new Africa Frontline First Catalytic Fund are a step in the right direction. The catalytic fund will support governments in Africa to build high-functioning, resilient, country-led community health systems alongside the Africa Frontline First initiative.
To realize AFF’s vision of 200,000 new community health workers in 10 African countries by 2030, more partners must step forward to fully fund the Africa Frontline First Catalytic Fund.
By leveraging the best of the private, public, and social sectors, we can ensure community health workers such as Getachew are equipped to save the lives of their neighbors, no matter where they live.
In addition to investments, we can all help amplify the critical role community health workers play in making sure everyone has access to essential health care. To help spread the word during the 77th session of the United Nations General Assembly, we invite advocates, private sector leaders, and government representatives to visit the UNGA events and activations hub to hear CHW stories, amplify their voices, and raise awareness of their critical work.
This opinion piece is co-authored by:
• Madeleine Ballard, executive director, Community Health Impact Coalition.
• Edward Booty, CEO, reach52.
• Workinesh Getachew, CHW in Ethiopia.
• Lisha McCormick, CEO, Last Mile Health.
• Carey Westgate, deputy director, Community Health Impact Coalition.
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