Best Investment for a Healthier World


Three Reasons to Invest in Community Health Workers

Raphael Salanga, a health surveillance assistant at the Nkhunga Health Centre in Malawi, administers a routine vaccine. Photo: Homeline Media

Raphael Salanga, a health surveillance assistant at the Nkhunga Health Centre in Malawi, administers a routine vaccine. Photo: Homeline Media

CHWs are trusted, capable, and cost-effective. 

Health systems cannot function without health workers.

That's why the World Health Organization (WHO) published the Global Strategy on Human Resources for Health to ensure the universal availability, accessibility, acceptability, coverage, and quality of the health workforce by 2030. As outlined in the strategy, just increasing the number of health workers is not enough. Health workers must be adequately trained, motivated, equitably distributed, and accessible to even the hardest-to-reach communities.

Despite efforts by global health leaders to substantially increase health financing and the recruitment, development, training, and retention of the health workforce in low- and middle-income countries (LMICs), major workforce shortages remain. For example, across Africa, there are only 1.55 health workers per 1,000 population, far below the WHO threshold for universal health coverage. 

Dr. Matshidiso Moeti, the WHO Regional Director for Africa says the shortage of health workers has daunting implications. “Without an adequate and well-trained workforce, tackling challenges such as maternal and infant mortality, infectious diseases, non-communicable illnesses, and providing essential basic services like vaccination remains an uphill battle,” she says.

With 2030 quickly approaching, the time to pivot is now.

CHWs are a solution.

 Community health workers (CHWs) in LMICs offer a sustainable solution to persistent health workforce gaps because they are:

  • Trusted by and dedicated to their communities
  • Capable of delivering a wide array health services
  • An excellent return on investment for governments and donors.

A trusted workforce

Communities in LMICs experience several barriers to accessing quality health care. Some people live hours from the closest health facility, while others need more education about what health services to seek or lack trust in the traditional health care system. For these reasons, CHWs are critical for primary health care delivery. They are trusted sources of health services and information for many communities, and are often the only touch point vulnerable populations in LMICs have with the health system.

“Whatever health issues come to the community, the CHW is the first person to take care of them,” says Dickson Nansima Mbewe, Health Surveillance Assistant (CHW), Malawi Ministry of Health. “They really appreciate the CHWs and they see the positive role we play.”

Communities trust CHWs because they proactively visit people’s homes to seek out illness, test and screen people for disease, and ask community members questions about their health and well-being. This trust was often amplified during the COVID-19 pandemic as CHWs were seen as a reliable source of continuous care. CHWs were also critical partners for addressing COVID-19 vaccine hesitancy in Africa.

“Community led, people centered, and integrated; these are the three ingredients for a successful CHW program,” said Josephine Kalombola, Health Surveillance Assistant (CHW), Malawi Ministry of Health.

A capable workforce

Given CHW’s ability to provide promotive, preventive, and curative health services into communities, and mitigate the effects of emergencies such as pandemics and climate change, CHW programs are seen as an essential component of a high-performing health care system. CHWs have proven to be reliable intermediates between the community and health sector, extending the reach of the health system to deliver a wide range of complex health tasks. CHWs have improved health outcomes in child mortality, HIV care management, TB control, and more. They improve maternal and child health services, expand access to family planning, and support the prevention and care of noncommunicable diseases.

Additionally, CHWs can help achieve the WHO Immunization Agenda 2030 by educating their communities about the benefits of immunization and in some cases, by administering vaccines. VillageReach published a rapid review of the global landscape and found that CHWs administer vaccines (both oral and injectable) in 20 countries. In the rare case of Malawi, CHWs lead the administration of all routine immunizations (including the COVID-19 vaccines), administering over 80% of vaccines across the country. One of the direct benefits of this approach in Malawi is that is shifts vaccine administration from nurses to CHWs, allowing nurses to focus on other tasks while still serving the community.

“All countries should consider CHWs as frontliners to be administering vaccines because of the trust the community has in them,” says Chifuniro Chiyendausiku, Health Surveillance Assistant (CHW), Malawi Ministry of Health. “They are the ones who spend more time in the community, and they know every member by location and sometimes by name.”

A cost-effective workforce

For funders and governments, CHWs offer an attractive return on investment (ROI) for human resources for health challenges. For every dollar invested in CHWs, governments can generate up to $10 return.  

This ROI accounts for (1) the increased productivity of a healthier population, (2) avoiding high costs from health system shocks with a reliable workforce, and (3) the economic impact of increased employment. Funding CHW programs offers an alternative to investing in physician or nurse training programs that may be more expensive and lead to the eventual migration of those trained workers.

Time for Action

Given the benefits of utilizing CHWs to fill health workforce gaps, it is critical to invest in and support CHWs now and ensure they are treated like professionals and are salaried, skilled, supervised, and supplied.

Currently, 86% of CHWs in Africa are unpaid despite working 30-40 hours a week, and they often do not have adequate training and supervision. Additionally, CHWs experience stock-outs of essential medicines 1/3 of the time, negatively impacting community access to life-saving medicines and vaccines. To address this, global health leaders must make evidence-based decisions and invest in research and programs that support CHWs and allow them to fill health workforce gaps and ensure equitable health service delivery.

"My call to action to leaders is this: you need us, you can't deliver health care without us, so move with the world and pay us, recognize us, and value us!" said Mbewe.