By: Mark Mwenda
Since January 2024, CHW Central has noticed a wealth of publications focusing on Community Health Workers (CHWs) across East Africa: 64 articles to be specific. In this summary of the recent evidence, I offer insights into the current state of CHW programs in the region and what the research tells us, including key learnings, challenges, and lingering questions that continue to shape the landscape of community health services in the region. By exploring the effectiveness, challenges, and innovations surrounding CHW programs, this brief summary highlights the critical role CHWs play in advancing healthcare in East Africa and the gaps that remain unaddressed.
Community Health Workers (CHWs) hold a unique and vital position within East Africa’s healthcare systems. They are often the first, and sometimes the only, link between remote, underserved communities and the broader medical world. They are the people who walk miles to provide care, educate communities, and ensure that health services reach even the most isolated populations (Nkurunziza et al. 2024). As I sifted through the recent research on CHWs across East Africa, I found myself reflecting on the significant challenges and the substantial promise that CHWs represent.
The studies I reviewed collectively paint a picture of CHWs as indispensable pillars of health systems, particularly in rural and underserved areas. CHWs are instrumental in addressing a wide range of health issues in the region, from maternal and child health to infectious diseases and chronic conditions (Semakula et al. 2024; Benoni et al. 2024). Their work is broad and impactful, but it is also fraught with challenges that, if not addressed, could undermine their effectiveness.
Health Education and Disease Prevention
A recurring theme across these studies is the critical role that CHWs play in health education and disease prevention (Musyimi et al. 2024; Chiziba and Silal 2024). Their close relationships with the communities they serve allow them to be effective educators, tailoring health messages in ways that resonate with local customs, languages, and beliefs (Onyango, Masinde, and Ouma 2024). This personalized approach often results in better health outcomes, as community members are more likely to trust and follow the advice of someone they know and respect (Asiimwe and Kadubira 2024).
In addition to their roles in health education and disease prevention, CHWs have made substantial contributions to the management of chronic and infectious diseases, as well as maternal and child health (MCH). Studies highlight how CHWs are instrumental in improving access to care for individuals with HIV, tuberculosis, diabetes, and hypertension, particularly in rural areas where healthcare services are limited (Semakula et al. 2024; Wallender et al. 2024; Kanyike et al. 2024; Youngui et al. 2024). CHWs support patients by offering home-based care, monitoring adherence to treatment regimens, and facilitating timely referrals to health facilities (Kanyike et al. 2024).
Furthermore, CHWs have played a critical role in reducing maternal and infant mortality by providing antenatal care, assisting with safe childbirth practices, and ensuring follow-up care for newborns and mothers (Gazeley et al. 2024; Awobode and Ansie 2024; Matte et al. 2024). Their ability to provide culturally sensitive and community-centered care significantly enhances the reach and effectiveness of health interventions targeting both chronic and infectious diseases, as well as MCH (Milka 2024; Youngui et al. 2024).
Data Collection
CHWs play a pivotal role in data collection, which is crucial for defining community health needs and shaping local health services. Several studies emphasize how CHWs, with their close ties to communities, are uniquely positioned to gather accurate, real-time data on health trends, disease outbreaks, and socio-economic conditions (Musoke et al. 2024; Manzi et al. 2024). This data informs local health policies and helps healthcare providers and policymakers tailor interventions to the specific needs of the community. For example, CHWs have been involved in mapping vaccination coverage gaps, identifying populations at risk of malnutrition, and monitoring the spread of infectious diseases, contributing to more responsive health service planning (Albin et al. 2024; Manzi et al. 2024). Their engagement in data collection also fosters community trust and ownership of health initiatives, as it ensures that health services are aligned with local priorities and challenges (Kanyike et al. 2024). By involving CHWs in data collection (and analysis), health systems become more adaptable and better equipped to meet the dynamic needs of the populations they serve.
Reducing Costs
One of the most compelling arguments for investing in CHW programs is their potential to reduce healthcare costs while improving outcomes (Manzi et al. 2024; Asiimwe and Kadubira 2024). By providing preventive care and managing chronic conditions at the community level, CHWs can help reduce the need for expensive hospital visits and treatments. This is especially important in resource-limited settings, where healthcare budgets are often stretched thin (Wambui et al. 2024). Yet, for this potential to be realized, CHW programs need stable funding, effective management, and continuous evaluation to ensure they are meeting their goals (Awobode and Ansie 2024).
Cultural Competence
A particularly striking aspect of the studies published so far this year is the emphasis on the importance of cultural competence in CHW programs (Milka 2024; Albin et al. 2024). CHWs often come from the communities they serve, which gives them a deep understanding of local customs, beliefs, and practices. This cultural competence is a powerful asset, allowing CHWs to deliver care in a way that is respectful and effective (Norr et al. 2024). However, the research also points to the need for ongoing training to ensure that CHWs can navigate cultural sensitivities, particularly as health issues evolve and new challenges arise (Uwibambe et al. 2024; Elias et al. 2024).
CHWs do not work in isolation, community support is an essential ingredient in the success of CHW programs (Plaisance et al. 2024). They are part of a broader community fabric that includes local leaders, health facilities, and other stakeholders. When communities actively support CHWs—through respect, cooperation, and local resources—these programs tend to be more successful (Otiso et al. 2024; Razafinjato et al. 2024). Conversely, when CHWs are undervalued or unsupported by their communities, their work becomes much more challenging.
Climate Change and Health
Climate change is increasingly recognized as a significant factor influencing the effectiveness and sustainability of Community Health Worker (CHW) programs across East Africa. As climate patterns shift, CHWs are often on the frontlines, dealing with the health consequences of these changes, such as increased incidences of vector-borne diseases, malnutrition, and waterborne illnesses. Extreme weather events like floods and droughts further complicate their work, as they struggle to reach affected populations, often in remote areas with limited infrastructure (Owoputi et al. 2024). These challenges not only strain the already limited resources of CHW programs but also highlight the need for climate-resilient health systems. Integrating climate change adaptation strategies into CHW programs is becoming increasingly crucial, ensuring that these essential workers are equipped to handle the growing health impacts of a changing environment.
“CHWs are often the first, and sometimes the only, link between remote, underserved communities and the broader medical world.”
Persistent Gaps
Despite the significant contributions CHWs make, the research highlights several gaps that need urgent attention. One of the most glaring is the inconsistency in training and supervision (Salomão et al. 2024; Ilboudo et al. 2024; Kwiringira et al. 2024). While some CHWs receive comprehensive training and ongoing support, others are left to navigate complex health challenges with minimal guidance (Kansiime et al. 2024). This disparity in training not only affects the quality of care CHWs can provide but also puts them at risk of burnout, as they are often expected to handle situations beyond their capacity (Pamba et al. 2024).
Compounding this issue is the lack of standardized compensation and support for CHWs in the region (Owoputi et al. 2024; Steinhaus et al. 2024; Davis et al. 2024). Many CHWs work as volunteers or receive very little pay for their efforts, which can lead to high attrition rates (Mulogo et al. 2024). The studies suggest that this lack of financial stability not only affects the well-being of CHWs but also the sustainability of CHW programs (Astawesegn et al. 2024). When CHWs leave their positions due to financial pressures, communities lose valuable health resources, and the continuity of care is disrupted (Olakkengil et al. 2024).
The research also indicates that there is a notable gap in the integration of CHWs into the broader health system (Mapulanga et al. 2024; Lee et al. 2024). While CHWs are often seen as an extension of the health system, they are sometimes left out of critical decision-making processes (Musyimi et al. 2024). This exclusion can lead to misaligned priorities and missed opportunities to leverage the unique insights CHWs bring from their communities (Garchitorena et al. 2024). Integrating CHWs more fully into the health system—ensuring they have a voice in planning and policy-making—could enhance their effectiveness and the overall responsiveness of health services.
CHWs need better tools and technologies to support their work (Mazimpaka et al. 2024). While some programs, such as Ethiopia and Kenya, have introduced mobile health (mHealth) solutions to improve communication and data collection, these technologies are not yet widely accessible or fully integrated (Hailemariam et al. 2024). The potential of digital tools to enhance the efficiency and reach of CHWs is enormous, but it remains largely untapped due to factors like cost, training, and infrastructure limitations (Kachimanga et al. 2024).
No Surprises
One striking realization from the 2024 publications so far is that much of the evidence presented reaffirms what has been known for years. The value of Community Health Workers (CHWs) and the barriers to their success are well-documented, and the recent literature largely echoes these familiar themes. While these studies continue to shed light on critical issues—such as the need for better training, more sustainable funding, and stronger policy support—these are challenges that have been consistently highlighted in the past.
This raises an important point: the real challenge we face is not merely in accumulating more evidence about the importance of CHW programs or the obstacles they encounter. Rather, the challenge lies in mobilizing the political will and securing the necessary investments to turn this knowledge into action. The recurring themes in the literature underscore a broader issue—an urgent need for tangible steps to be taken by governments, implementing partners, and CHW associations (where they exist) to address the persistent gaps.
Reflections on the State of the Evidence
Reflecting on these findings, I am struck by the incredible potential of CHWs to transform healthcare in East Africa. They are already doing so much with so little, but with the right support, their impact could be even greater. Addressing the gaps in training, compensation, integration, technology, and community support is not just about improving CHW programs—it is about strengthening the entire health system.
These insights resonate with my own experiences and aspirations in the field of community health. As someone deeply committed to the well-being of communities, I see the empowerment of CHWs as a crucial step toward achieving health equity in East Africa. It is clear that CHWs are not just foot soldiers in the fight for better health; they are leaders, educators, and advocates who hold the key to a healthier future for all.
Moving forward, it is essential that policymakers, healthcare providers, and communities work together to address the challenges facing CHWs. This means investing in their training and support, ensuring they are fairly compensated, and integrating them more fully into the health system. It also means embracing new technologies that can help CHWs work more efficiently and effectively.
The lack of advocacy for CHWs remains a significant barrier to governments fully recognizing and appreciating the critical role they play in healthcare systems. One potential solution to this challenge is the development of strong, unified CHW associations. These associations could serve as a powerful platform for CHWs to collectively advocate for their rights, better working conditions, and sustainable employment models. By amplifying the voices of CHWs, associations could engage policymakers, secure long-term funding, and ensure that CHWs are fully integrated into national health systems. Moreover, CHW associations could offer professional development opportunities, standardize training, and provide a structure for ongoing peer support, all of which would enhance the effectiveness and retention of CHWs. In many regions, similar professional groups have been instrumental in influencing health policy and driving systemic change, and CHW associations could play a vital role in transforming the way community health services are valued and delivered.
Ultimately, the future of healthcare in East Africa—and indeed, in many parts of the world—depends on the success of CHW programs. By addressing the gaps identified in these studies and building on the strengths of CHWs, we can create a more just, equitable, and effective healthcare system. It is a vision that I am committed to pursuing, and I believe that with collective effort, it is a vision that can be realized.
The story of CHWs in East Africa is one of resilience, dedication, and hope. It is a story that deserves our attention, our investment, and our support. As we look to the future, let us not forget the vital role that CHWs play in our communities—and let us do everything we can to ensure they have the tools, resources, and respect they need to continue their essential work.
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