Advance Community Health Worker Programs to Accelerate the Achievement of Universal Health Care and Primary Health Care: The 3rd International Community Health Worker Symposium

By: Christina Berry-Moorcroft, Marion Subah, Kayleigh Begley, Katey Linksey, Kristiana Bruneau, Amy Collins, Naomi Senda

In just a few days, from 22-24 March, Ministers of Health, health and finance experts, multilateral organizations, community health workers, development agencies and partners, will come together for the 3rd International Community Health Worker Symposium, to push for a better supported and integrated community health workforce. Community Health Workers (CHWs) are people trained and certified to provide basic health services to their neighbors. Their work is done quietly, supporting communities at multiple levels – delivering primary health care services to their neighbors, building capacity, providing support, and undertaking and supporting the delivery of key services. While their impact is known to those who are directly served, countries still struggle to truly showcase the full value CHWs have in supporting treatment and psycho-social support, providing referrals, and preventing both infectious and non-communicable diseases.  They are often overlooked in the health, social and economic system,  and their work is discounted, with nonexistent or insufficient salaries, and often not included as a component of a functioning health workforce. As we look to strengthen primary health care to support attainment of universal health coverage, we must challenge this status quo: it is CHWs that are best positioned to support this demand, with evidence showing that their services are cost effective and critical.

CHWs: The Local Healthcare Providers

Meet Pauline Lominae – the ‘Village Doctor’. Pauline is a volunteer Community Health Worker in Kenya. She was trained at Daaba Health Facility, which is located in the arid and sparsely populated Isiolo County. Each week, she travels house to house throughout her community, carrying her medicine bag on her shoulder, and serving mothers, children, and the most in need. Each day, Pauline brings essential and life-saving health services to people’s doorstep ensuring access to healthcare for all. Despite her passion for the work she does, as she shared in an interview with Living Goods, there are significant challenges. “The distance from one client to another is quite long. It is always hot, dry, and dusty—yet I have to trek on foot to reach my clients. I cannot afford the luxury of a motorbike. But either way, I carry on because my people depend on me.” The pay she receives is done inconsistently and supported through donors. As Pauline suggests, the health of the population should be the government’s priority, and they should ensure that the wages/stipend to these workers is part of national policies, and provided consistently.

Heroes of the COVID-19 Pandemic

Faced with an unprecedented global health emergency, the COVID-19 pandemic brought to light the fragility of the health system, and the interconnectedness of the social, health and economic systems. As countries grappled with challenges on all fronts, it was frontline community health workers, who delivered a first response. They played a pivotal role in surveillance, community sensitization on COVID-19 prevention and home-based care, and enforcing protocols by local Ministries of Health to help flatten the curve and contain the pandemic.

Meet Naomi, James and Mardea: they are CHWs employed through Liberia’s flagship National Community Health Assistant Program. In the midst of the pandemic, they led efforts to educate neighbors on disease transmission, handwashing, and home isolation protocols. They also supported efforts to screen and refer households. Beyond COVID-19, the flagship program has seen over 4,000 community and frontline health workers undertake more than 5 million home visits to treat nearly 1 million cases of childhood pneumonia, malaria, and diarrhea. Naomi, James, and Mardea all indicate that critical to their work is adequate compensation and access to personal protective equipment. 

Working at the heart of communities, CHWs are providing essential health services, but are also working in education, sensitization, health promotion and prevention. They provide valuable leadership, guiding individuals in their search for support in all different capacities. Best case practices, provided by the World Health Organization, highlight that for the full potential of CHWs to be realized, they must be provided with fair payment, the right levels of training and support, clinical supervision, and supplies. A key strategy to accelerate progress is to commit to, invest in, and expand, Community Health Programs, that empower CHWs. Through these programs, countries can deliver affordable health care to people in most hard to reach places, enabling meaningful progress to be made towards attainment of the Sustainable Development Goals (SDGs). As governments meet in Monrovia for the 3rd International CHW Symposium to discuss best practices and share knowledge, the time is now to take action, to build political will, and re-affirm commitments that ensure sustainable and integrated community health worker programs.

About the 3rd International Health Workers Symposium
The Symposium is being held at the Ellen Johnson Sirleaf Inter-Ministerial Complex in Monrovia, Liberia over three days, March 22 – 24, 2023 with two days’ pre-conference March 20-22, 2023. The Symposium will amplify the centrality of the workforce, especially CHWs, in ensuring a resilient health system for the future.  This symposium builds on the previous two CHW Symposiums held in Uganda in 2017, Bangladesh in 2019, and the Institutionalizing Community Health Conferences (2017 & 2021). It will bring together more than 45 countries, including CHWs, government representatives, including select Ministers of Health, implementing partners, donors, and other stakeholders. For more information, see the CHW Symposium Website.