Opinion: Community health workers are key to expanding medical care

Rosemary Wanjiru is a community health volunteer in Kenya. Hanna Belayneh is Policy and Advocacy Officer at Results Canada.

Rain or shine, I have walked the narrow lanes of my neighborhood in Nairobi, Kenya for 18 years, providing lifesaving treatment and education on HIV and TB to those who need it most.

And I’m not alone. In many countries Around the world, lay health workers selected and trained to work in their communities are making health care accessible to millions of people every day. From Haiti companions to village health team workers in Uganda, at Shasthya Shebika in Bangladesh, Community Health Workers (CHWs) are trusted neighbors with a mission: to bring compassionate care to the doorsteps of those who are often left behind – those who live in poverty and face complex challenges in accessing health care, including the high cost of treatment and transport, distance and the stigma associated with the disease.

As they go door to door to visit a patient who is starting TB treatment to make sure he is taking his medication correctly, watching a pregnant woman who probably has no access to facility-based antenatal care or vaccinating a child who otherwise would not be able to get vaccinated, CHWs become bridges that extend the reach of health services well beyond facilities into homes. Simply put: community health workers are the most effective and equitable way to expand access to primary health care.

The results speak for themselves. Take Ethiopia: Health extension workers – local community health workers – are widely regarded as the main reason why the country has achieved some of the most notable improvements in health of any African country, with a significant drop in maternal mortality and child mortality children under five.

Pandemics, past and present, have highlighted how reliably CHWs can be relied upon in times of crisis. In Liberia, for example, CHWs were on the front line of the response to Ebola outbreaks, finding people with the disease and tracing their contacts. Now they are fully engaged in the prevention, detection and response to COVID-19.

The fact that investing in community health workers yields high returns and is our best bet for expanding access to primary health care has been made clear. Yet, in direct contradiction to this overwhelming evidencecommunity health workers around the world are under-prioritized and under-resourced.

Without effective integration into health systems structures, CHWs are not always properly identified or recognized as a key health workforce. The vast majority remain underpaid, or totally unpaid – in Africa, for example, only a dismal 14 percent CHWs are salaried. Essentially, more often than not, community members bear the heavy responsibility of leaving no one behind, while they are unpaid, with little or no incentive, without proper equipment, without ongoing training and with no prospects for career.

It defies common sense, and it has to change. CHWs are essential in preventing and responding to health threats and must be supported and compensated if they are to be trained and retained.

As we reimagine the future at 24th International AIDS Conference held in Canada this summer, we must make smart and sustainable investments in the frontline people who are the very foundation of effective and resilient health systems. The Global Fund to Fight AIDS, Tuberculosis and Malaria – the largest multilateral provider of grants to build resilient and sustainable health systems – offers us the opportunity to do just that. Recognizing that trained, motivated, equipped and properly compensated frontline workers are the irreplaceable component of an effective and resilient health system, the Global Fund has been investing vigorously in community health workers around the world for decades.

This year, with a replenishment of at least US$18 billion, the Global Fund would have the resources to scale up these investments. If we are truly committed to reducing health inequalities and ensuring access to basic health services for all, it is imperative that we join the Global Fund and leverage its contributions to community systems.

To reimagine a more equitable model for all and prevent the next pandemic, we must not be myopic. We must heed the calls of visionary pioneers such as the late Dr Paul Farmer, who repeatedly said that there is no better tool to deal with the suffering of those without access to formal health care than deep and lasting accompaniment by trusted neighbors through their journey to health. The organization he co-founded, Health Partners, tells us that “injustice has a remedy”. Community health workers are the cure.

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