A Call to Scale-Up Community Health Workers

Public health officials and practitioners from around Africa and from international public and private organizations, businesses, and universities, met in Accra, Ghana June 9-11 to consider ways to scale-up the coverage of high-quality community health worker systems in our countries to achieve universal health coverage.
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This post is co-authored with Sonia Sachs on behalf of the 1 Million CHW Campaign.

Public health officials and practitioners from around Africa and from international public and private organizations, businesses, and universities, met in Accra, Ghana June 9-11 to consider ways to scale-up the coverage of high-quality community health worker (CHW) systems in our countries to achieve universal health coverage (UHC). In the meeting they pledged to work together to speed the scale-up of CHW systems in sub-Saharan Africa, and issued the following urgent appeal.

Joint Call to Action

We have reviewed the national experiences and the scholarly evidence demonstrating that CHW systems are a critical, integral, cost-effective, and long-term part of effective overall health systems. CHWs save lives, promote public health and wellbeing, bridge health system gaps, improve the quality of life, and help to prevent and end epidemics like Ebola. As members of the communities they serve, CHWs are the health workers closest to households. CHW systems offer high-quality, meaningful employment for young people.

We know that effective national-scale CHW systems start at home. We urge all African governments, including Ministers of Finance and Health, to recognize the indispensable role of CHWs in public health and epidemic control, by taking the following steps:

  1. Making and implementing plans for national-scale CHW systems;
  2. Expanding the domestic funding available for CHW systems;
  3. Ensuring that CHWs are properly trained, remunerated, supported by cutting-edge information systems, and empowered with the proper supplies, equipment, and training needed to provide both preventive and curative care with professional skills and to empower communities in their own health;
  4. Preparing CHW systems to address the non-communicable disease challenges that will be central to the new Sustainable Development Goals (SDGs);
  5. Supporting CHW systems with state-of-the-art information and communications systems made possible by breakthroughs in mobile broadband, telemedicine, remote monitoring, remote diagnostics, and other recent ICT innovations of great promise and significance;
  6. Empowering communities to work effectively with CHW systems;

On the international side, we underscore the urgent need to scale-up international support for CHW systems, and to convert the fragmented global CHW funding into pooled financing that supports national CHW systems. We are concerned about donors supporting parallel programs rather than national programs. Because of such parallel programs, CHW systems are scattered across many projects, each with its own protocols, ICT systems, if any, varied durations, and inconsistent approaches on training and the range of activities of the CHWs.

We strongly urge donors to pool their CHW resources into a few pooled global funds, including the Global Fund to Fight AIDS, TB, and Malaria, GAVI, the new Global Finance Facility, and possibly a new Global Fund for Health Systems. These pooled funds should provide additional financing for CHWs in a flexible and timely manner. We call on the donor partners to end the donor fragmentation and the long delays in disbursements. The time for scale-up has arrived.

We note that two countries in Africa, Guinea and Sierra Leone, are still battling Ebola, while Liberia has succeeded in ending their Ebola epidemic in part through the successful deployment of community health workers. Ebola is a scourge that takes hold in places with under-financed and fragmented health systems that lack effective CHW system support. We call on the international community to support the Ebola-affected countries to scale-up their national health systems, including high-quality CHW systems, with full urgency.

We note that the world is on the verge of adopting the new SDGs, calling among other things for UHC as part of SDG 3. We also note that world leaders will assemble in Addis Ababa, Ethiopia next month to take steps to finance the new SDGs. We firmly believe and declare that success in universal health coverage will require the proper funding and scale-up of CHW systems in our countries and throughout Africa. We call on world leaders to heed the exciting opportunities at hand to save lives by the millions in the coming years through professionalized, high-quality CHW systems linked to overall high-quality health care systems.

We address this appeal to the leaders of national governments and the international health organizations. We kindly request the One Million Community Health Workers Campaign report back to the participating governments in advance of the UN SDG Summit in September 2015, so that we can move forward effectively and confidently together in an urgent and timely manner.

June 11, 2015

Adopted by acclamation with:

Government representatives from:

Ministry of Health, Burkina Faso
Ministry of Finance, Burkina Faso
Ministry of Health, Congo-Brazzaville
Government of Ghana
Ministry of Health, Ghana
Ministry of Finance, Ghana
Ghana Health Services
Ministry of Local Government and Rural Development, Ghana
Ministry of Health and Public Hygiene, Guinea
Ministry of Health, Kenya
Ministry of Health and Social Welfare, Liberia
Ministry of Finance, Liberia
Ministry of Health, Malawi
Ministry of Finance, Malawi
Ministry of Health, Mozambique
National Primary Health Care Development Agency, Nigeria
Ministry of Health, Rwanda
Ministry of Health and Social Action, Senegal
Ministry of the Economy, Finance, and Planning, Senegal
Ministry of Health and Sanitation, Sierra Leone
Ministry of Finance, Sierra Leone
Ministry of Health, Uganda
Ministry of Finance, Uganda
Ministry of Health and Social Welfare, Tanzania
Ministry of Finance, Tanzania
Ministry of Community Development, Zambia
Ministry of Health, Zambia

Representatives from:

Brandeis University
Earth Institute at Columbia University
Moi University
Clinton Health Access Initiative, Zambia
Columbia Global Center East & Southern Africa
Columbia Global Center West & Central Africa
Global Health Workforce Alliance (GHWA)
Harvard University
Tanzanian Training Centre for International Health
Johns Hopkins University
Last Mile Health
Living Goods
Management Sciences for Health, USA
Management Sciences for Health, Ghana
Management Sciences for Health, Rwanda
Millennium Development Goals Health Alliance
Millennium Promise Inc.
Millennium Villages Project, Ghana
CORE Group
National Health Insurance Fund, Ghana
Sanford International Clinics, USA
Sanford International Clinics, Ghana
Save the Children, Sierra Leone
Sustainable Development Solutions Network
University of Ghana School of Public Health
University of Washington
WHO Ghana
World Vision International
World Vision, Ghana

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