Community Health Workers

In many parts of the world, millions of children and mothers suffer or die unnecessarily from preventable and treatable diseases because they have limited or no access to basic aspects of modern medicine – clinics and hospitals are simply too far away This is where Community Health Workers (CHWs) come in: A CHW who is properly trained, equipped, supervised and motivated can diagnose and treat many of the most common causes of suffering and death – providing access to care for remote populations and helping countries reach the health MDGs. But many CHWs are unable to reach their full potential due to insufficient funding for training and for the medicines and diagnostics that CHWs carry. Variations in standards and poor connectivity to health systems also undermine CHW performance. In such cases, not only are CHWs unable to provide effective care for the top killers of children, they are also under-prepared to provide support for pregnant women and newborns.

Target

For a targeted set of ~15 countries, mobilize funding for CHW programs and for integrated Community Case Management, improve program operating models, and disseminate evidence that helps improve frontline delivery of life-saving health services at the community level. Estimated impact in 2015 is ~250,000 additional lives saved.

Situation

Diarrhea, pneumonia, and malaria account for around thirty-five percent of under-five deaths. Facility-based services are unable to reach all vulnerable populations in many rural, high-burden contexts, leaving a significant ‘treatment gap’ at the last mile. In many settings, Community Health Workers exist but could be more effective than they are today – lack of training, supervision, incentives, and reliable flow of medicines and supplies reduces the impact CHWs could have on their communities. Country-by-country analysis can identify the most critical challenges in each geography and estimate the cost of resolving these situations. In addition, extensive resource mobilization is necessary to address challenges, provide existing and better tools, and scale programs.

Approach

The UN Special Envoy’s office is primarily focused on supporting partners that work in four areas to address the challenges confronting successful scale up of Community Health Worker Programs:

1. Mobilizing resources for frontline delivery: Countries need additional assistance to leverage emerging funding opportunities to support scale up of CHW programs. Such opportunities include bilateral and multilateral donors, domestic sources, and private foundations.
2. Overcoming critical bottlenecks and creating investment cases: In some high-burden contexts, effective delivery of life-saving interventions at the frontlines may require policy shifts at the country level (i.e. enabling CHWs to provide antibiotics for simple pneumonia). These policy shifts may also be strengthened by changes to the programmatic model (i.e. moving from volunteer to paid CHWs or shifting from ‘push’ to ‘pull’ supply chain systems). Technical experts from the CCM Task Force, the One Million Community Health Worker Campaign and other groups can work with country-based coordinating teams to define these critical bottlenecks and find solutions. These programmatic analyses and modifications should be conducted in close alignment with the gap analysis activities given potential cost implications.
3. Marshalling evidence to support higher levels of impact: While some countries are at a beginning level of frontline delivery and require policy and programmatic shifts to address key bottlenecks, other countries have been deploying community health workers for years and require additional evidence, information, and innovations to take their programs to higher levels of impact and cost effectiveness. The CCM Task Force, One Million Community Health Worker Campaign, and additional groups can help countries in identifying best practices and optimizing program models.
4. Advocacy and awareness raising: Increased funding and emphasis on health system strengthening and community delivery requires further advocacy among policy makers, government leaders and donors. The Global Health Workforce Alliance, the Frontline Health Worker Coalition, the CCM Task Force, and other partners are pushing for increased attention and prioritization around CHWs among key policy makers.