Despite medical and technological advances, half the world’s population lacks access to essential health services. More than 8.9 million preventable deaths occur every year. There is an acute shortage of health workers, a gap that will grow to 18 million by 2030. Training high-performing community health workers (CHWs) can help close these gaps and save more than 3 million lives annually. In the past few decades, many CHWs programmes across the world have demonstrated their ability to save lives. Lessons on how to successfully scale these programmes as part of national primary health systems are not widely shared. CHWs can bridge the gap between communities and the formal health system, bringing healthcare as close as possible to where people live and work, delivering health for all.
Community health worker programmes for universal health coverage
Highlighting components of community health systems and lessons learned from a range of contributors
- More than half the world’s population has no access to basic quality healthcare.
- The world needs some 18 million more health workers.
- A community health worker prevents a child dying somewhere in the world every three seconds.
- Most community health workers are volunteers. One of the biggest challenges facing health systems, particularly in developing countries, is how to pay them.
SynopsisMore than half the world’s population has no access to basic quality healthcare and over 400 million people have no access to health services of any kind. Meeting the UN Sustainable Development Goal on universal health – SDG 3 – will mean more and better spending on health, particularly on primary healthcare. It will also require shifting the emphasis from cure to prevention. The cost of additional health workers needed to meet the UN health goal amounts to half of the financing gap. Currently, the world needs some 18 million more health workers, mainly at primary care and community health level. Nurses account for 9 million of this figure, with community health workers accounting for another 4.5 million. Most community health workers are volunteers. One of the biggest challenges facing health systems, particularly in developing countries, is how to pay them when health budgets are tight and how best to integrate them into national health services. Some level of remuneration is considered crucial. Women already have too many non-paid tasks – it is unfair to add another. The value of community health workers to health systems is immense. It is estimated that a community health worker prevents a child dying somewhere in the world every three seconds. They are from the community they serve and know how to translate the medical jargon into language that is comprehensible to their patients. It is not just a question of fairness. Paying health workers brings wider economic benefits. Not only does the money contribute to the wider economy, but the provision of better health services helps reduce migratory pressures. One way to provide income to voluntary health workers would be to adopt an entrepreneurial approach and allow them to sell certain health commodities, for example, bed nets in malaria-prone areas. But spending on community health workers, as spending on other areas of health systems, needs to be seen as an investment and not pure expenditure. This requires a change of mindset on the part of budgetary authorities. South Africa offers an example of how paying community health workers generates positive results. The mother2mothers programme, which focused initially on stemming the transmission of HIV from mother to child, has around 10,000 paid women mentors. Transmission of HIV from mother to child has been practically eliminated in South Africa. The service has reached over 10 million women and their families. Male nurses were initially circumspect but have become firm supporters because they see the mentors as fundamental to the delivery of services to pregnant women.
There needs to be a change of mindset on the part of budgetary authorities. Health spending has to be seen as an investment and not just expenditure.