Community health workers at the dawn of a new era

Abstract

Background There is now rapidly growing global awareness of the potential of large-scale community health worker (CHW) programmes not only for improving population health but, even more importantly, for accelerating the achievement of universal health coverage and eliminating readily preventable child and maternal deaths. However, these programmes face many challenges that must be overcome in order for them to reach their full potential. Findings This editorial introduces a series of 11 articles that provide an overview highlighting a broad range of issues facing large-scale CHW programmes. The series addresses many of them: planning, coordination and partnerships; governance, financing, roles and tasks, training, supervision, incentives and remuneration; relationships with the health system and communities; and programme performance and its assessment. Above all, CHW programmes need stronger political and financial support, and this can occur only if the potential of these programmes is more broadly recognized. The authors of the papers in this series believe that these challenges can and will be overcome—but not overnight. For this reason, the series bears the title “Community Health Workers at the Dawn of a New Era”. The scientific evidence regarding the ability of CHWs to improve population health is incontrovertible, and the favourable experience with these programmes at scale when they are properly designed, implemented, and supported is compelling. CHW programmes were once seen as a second-class solution to a temporary problem, meaning that once the burden of disease from maternal and child conditions and from communicable diseases in low-income countries had been appropriately reduced, there would be no further need for CHWs. That perspective no longer holds. CHW programmes are now seen as an essential component of a high-performing healthcare system even in developed countries. Their use is growing rapidly in the United States, for instance. And CHWs are also now recognized as having a critically important role in the control of noncommunicable diseases as well as in the response to pandemics of today and tomorrow in all low-, middle-, and high-income countries throughout the world. Conclusion The promise of CHW programmes is too great not to provide them with the support they need to achieve their full potential. This series helps to point the way for how this support can be provided.

The Lancet Global Health Commission on financing primary health care: putting people at the centre

“…Securing sustainable financing for community health worker programmes can be a challenge, particularly as in many countries these rely on external funding. 37 Debates about paying community health workers typically focus on the trade-offs between reliance on volunteerism underpinned by intrinsic motivation of volunteers and the need to recognise and remunerate work fairly (and in doing so, addressing gender disparities, as most of the community health worker workforce is female). 38 , 39 Section 5 includes a brief summary of the evidence on paying community health workers.…”

Effectiveness and Coverage of Treatment for Severe Acute Malnutrition Delivered by Community Health Workers in the Guidimakha Region, Mauritania

“…This result is consistent with our hypotheses that CHWs can increase coverage of acute malnutrition treatment. Zulu and Perry 2021, in a recent series found that the large-scale involvement of CHWs in the health care system has a huge potential for accelerating universal health coverage and improving population health [ 29 ].…”

Motivation and Performance of Community Health Workers: Nothing New Under the Sun, and Yet…

“…A cursory reader well-versed in CHW programs (for example, the 20-year-old seminal publication of Bhattacharyya et al on CHW incentives and disincentives 5 ) might be forgiven for pondering, “We already know that both financial and nonfinancial incentives matter if we want motivated and performing CHWs. What is new in this?” The question is timely as a new Health Research Policy and Systems 6 supplement issue (including a summation of lessons on incentives and remuneration of CHWs 7 ) now updates the work of Bhattacharyya et al, 5 the CHW Reference Guide, 8 and more recently, the 29 country case studies by Perry on national CHW programs. 9 Indeed, some findings recur across contextual studies and accrue a recognizable body of evidence, even if they do not have the sharp edges of controlled experiments.…”