ACHIEVING HEALTH FOR ALL & PROCHWs.

Achieving health for all is a moral imperative. Since 2012, it has also been a promise. Under Sustainable Development Goal 3, all nations of the world made a bold commitment to achieve universal health care, provide access to safe and affordable medicines and vaccines for all, and end epidemics of AIDS, tuberculosis, malaria and other communicable diseases — by 2030. 

But, despite decades of global health investment, today over half the world’s population lack access to essential health services. They live in both rural and urban areas, commonly defined as the hardest-to-reach communities.

The traditional health delivery model demands that families find their way to a doctor or hospital for their healthcare needs. But millions of families live hours—sometimes days—from the nearest clinic, often in the poorest communities. So for many — unable to shoulder the relatively high cost of transport, as well as the cost of long absences from employment or farming —it’s an automatic death sentence. The standard solution of building more clinics and hiring more doctors—is insufficient. New clinics have conspicuously failed to reach those living in the most remote communities. 

Health for all requires delivery for every person in every village. And if the world is to keep its promise, we must accelerate progress in the next five years. We cannot afford to keep wasting money and resources, and failing the most vulnerable, with poor service design.

“We CHWs are the bridge between communities and healthcare, walking alongside families every step of the way. Without us, reaching the last mile of UHC would be a much longer journey.”

Ramatu Jalloh, CHW Supervisor, Partners in Health, Sierra Leone

 

But, we can reach health for all by seeking new opportunities in an old idea: community health workers (CHWs).

By organising, training and supplying existing community members to deliver a wide range of healthcare services, we can not only demolish barriers to access but grow healthier communities. CHWs bring primary health services straight to their neighbors’ doorsteps. CHWs also foster greater community trust and become a first point of contact, positioning them to engage communities in more effective preventive and promotive health activities and education, from the use of bed nets to prevent malaria contraction to family planning services and pandemic preparedness.

“Community health workers play a fundamental role in providing holistic health services to their communities. Treating us as professionals is the least that can be done to recognize our monumental labor and improve global healthcare coverage”.

Margarita Enedina Perez Santizo, CHW, Mexico

CHWs’ unique power to overcome barriers to access and service the hard-to-reach became more clear than ever during the COVID-19 pandemic. At this time, it became impossible to ignore that our individual health is only as strong as our neighbor’s health. And that a robust health system is founded on a well-supported workforce. 

Faced with this crisis, well-supported and protected community health workers continued to provide healthcare services to millions of people. Using rapidly adapted protocols and armed with PPE, CHWs ensured patients could continue to access essential health information and services. Even as the locus of care shifted from health facilities to homes.

“With public transport suspended and movement restricted, individuals with pre-existing health conditions faced difficulties in accessing essential medications and seeking medical care. As a CHW, I found myself at the forefront of efforts to bridge this gap by coordinating with local health facilities to ensure continued access to medication refills and urgent healthcare services.”

Irene Tukashba, CHW, Living Goods, Uganda

And it’s happened before. The 2016 Ebola epidemic marked a turning point for Liberia’s health service, which was forced to innovate in the face of disaster. As a result, the community health model was thrust center stage—providing, among other things, an early warning system for outbreaks.

CHWs’ ability to rapidly identify infections was crucial in ending the outbreak in 2016—the same year the model was scaled nationally. CHWs were more effective at carrying out Ebola-related activities than outsiders. 

Thanks to these successes, health systems the world over have been embracing the value of CHWs in extending essential services, improving health equity, and progressing toward health for all. However, too often attempts to replicate these game-changing successes, and scale them to reach everyone, have failed to invest in CHWs and set them up to succeed. That means ensuring CHWs are salaried, skilled, supervised and supplied. Or in other words, treated as the professionals they are. 

“CHWs play a critical role in grassroots health care and are essential for achieving UHC. All we need is to be well supported, equipped and trained.”

Loise Nyaboke Nyachio, CHW, Ministry of Health Kenya

Fighting one injustice (lack of access to health) by perpetuating another (not paying CHWs) is not justice. Demanding that individuals volunteer to access healthcare for themselves and their families is an act of coercion.

To date, 43 countries have professional CHW (proCHW) policy, where at least one CHW group is salaried and accredited. The majority of CHW programs continue to rely on unsalaried volunteers. This dependence on volunteers means many programs struggle to maintain the necessary staff levels to keep these critical programs afloat. And when they do, they are once again depending upon some of the most disadvantaged to carry the burden of delivering global health targets. So it’s a dual human rights problem: CHWs are exploited and less effective for patients.

“Imagine you’re working a really important job helping people in your community stay healthy. But, the pay is so low you can barely afford food and clothes for yourself and your family. It’s hard to feel motivated and stay in that job when you’re struggling to make ends meet.”

Ramatu Jalloh, CHW Supervisor, Partners in Health, Sierra Leone

 

When these programs are not appropriately supplied with medicines or personal protective equipment – as we saw with many programs during COVID-19 — service quality suffers and the people who depend upon those services are stuck with second-class healthcare. And CHWs are forced to sacrifice or risk their own health in the line of duty.

Now is the time to dismantle this inequitable system. One that depends on unpaid labor from socio-economically disadvantaged communities. And put in its place a system in which we guarantee health for all, including those who provide it. 

“By working together and prioritizing the needs of the most vulnerable, we can ensure that healthcare becomes a fundamental right.”

Irene Tukashba, CHW, Living Goods, Uganda