Strengthening primary health care through community health workers

Date published on source: 
20 July 2015
Source organisation: 
MDG Health Network
Keyword tags: 

As we enter the final months of the Millennium Development Goal (MDG) period, the world is at a critical moment of reflection and aspirational forward thinking. While significant progress has been made on the health MDGs (including a global reduction in the child mortality rate by nearly 50% since 1990 and the maternal mortality ratio by 45% in the same period), it is now clear that we will not meet the targets for these MDGs, goals 4 and 5 respectively.

Additionally, as the Ebola outbreak slows in West Africa, the world is attempting to understand how this outbreak became so severe so quickly and how future health crises might quickly be contained. In this context, world leaders are setting health targets for the next phase of global development that focus on championing the achievement of universal health coverage (UHC).

An emerging consensus among global health leaders is that building stronger health delivery systems, with particular emphasis on community-based primary health care, will be required in the future—to ensure adequate preparedness against future epidemics, to continue the fight against the top killers of children and mothers around the world, and to build capacity to handle the growing burden of chronic, non-communicable diseases. This will involve harnessing the potential of multidisciplinary care teams (including CHWs, mid-level workers, and professional health workers) to extend health services to poor and marginalized populations.

Within this mix of skills, cadres of trained Community Health Workers (CHWs) can play an important role in increasing coverage of essential healthcare interventions and enhancing the resilience of health systems to crisis. Indeed, CHWs have been cited repeatedly by leaders such as Liberia’s President Ellen Johnson Sirleaf as essential in responding to health crises, delivering routine care, and providing linkages to the health system for hundreds of millions of individuals in Africa and around the world.

Despite the progress some countries have made in scaling up CHW programs, many countries that would benefit from strong CHW cadres currently have only ad hoc, sub-scale programs. This problem extends even to high-income countries that would benefit from CHW programs to provide cost-effective care and battle chronic disease. Countries wishing to scale these programs using a coordinated national strategy face many challenges. Chief among these challenges are limited political prioritization of CHWs and a subsequent lack of financing: insufficient and inaccessible international funding as well as limited alignment on pathways for domestic financing.

These challenges were taken up by a high-level panel convened by Prime Minister Hailemariam Dessalegn of Ethiopia and Ray Chambers, the United Nations Secretary General’s Special Envoy for Financing the Health MDGs and for Malaria. This report states the three key takeaways from this panel’s investigation of CHW financing and offers seven recommendations to support countries in the development of strong, integrated CHW programs.

Over the course of this panel’s investigation into CHW financing, three key takeaways emerged:

  • There is a strong case for investment in CHWs as a component of primary health care
  • When building CHW programs, maintaining ten core principles and a focus on performance management will ensure return on investment (ROI)
  • Sources of financing for CHWs exist, but countries must be proactive to assemble a financing pathway for their system.

*  Access the report here

*  Further information on the report can be accessed here