ADVANCING PROCHW POLICY IN A FRAGMENTED GLOBAL CONTEXT.

A SHIFTING LANDSCAPE FOR HEALTH SYSTEMS.

Systems that have shaped global health cooperation for decades are fragmenting. Countries are adapting in real time. Long-standing practices around stable institutions, shared norms, and financing are no longer holding — and the implications for health systems are becoming harder to ignore.

Earlier this year, at the World Economic Forum, Canada’s Prime Minister declared that the post-1990 “rules-based international order” is effectively over. What’s emerging isn’t a single alternative, but a different way of operating.

The global system that many countries relied on is becoming less predictable and more politicized. As interdependence is used as leverage, middle-income and emerging economies can no longer assume the old rules will hold. Many are responding by building strength at home, diversifying partnerships, and working through smaller, issue-specific coalitions.

HOW THIS RESHAPES HEALTH PRIORITIES.

As global institutions weaken — including UN systems and World Health Organization–style norm-setting — three dynamics are becoming harder to ignore:

Global standards are increasingly contested
Values-based language risks losing its meaning without enforcement
Health financing is tied more explicitly to national interests

This does not mean abandoning health as solidarity.

It means adding a second argument that is resonating more strongly in today’s geopolitical context:

Health = strategic resilience.

A Community Health Worker measuring the arm of a child while two other adults assist her

Last Mile Health

HOW COUNTRIES ARE RESPONDING IN PRACTICE.

Recent developments in Kenya and Mozambique illustrate what this shift looks like on the ground. Both point to a common conclusion: Community Health Workers (CHWs) who are salaried, supplied, supervised, and supported form a critical foundation for resilient health systems.

In Kenya, Dr. Ouma Oluga, Principal Secretary of Health, emphasized the government’s long-term commitment to this approach, describing professional CHWs as “the foundation of resilient healthcare systems.” Kenya has moved to formally salary its community health workforce and integrate it into national health delivery.

Mozambique offers a similar political commitment translating into budgetary reality. Minister of Health Hon. Ussene Hilário Isse has underscored that the community subsystem is treated as a pillar of government, with CHWs increasingly integrated as state employees and compensated through domestic financing rather than donor dependence.

Together, these examples reflect a broader pattern: when countries invest in professional CHWs (proCHWs) as part of core health infrastructure, they are investing in continuity, legitimacy, and delivery capacity under stress.

COMMUNITY HEALTH WORKERS FIT THIS MOMENT.

proCHWs are not just a social good.
They are a strategic investment in health systems.

The evidence is clear: proCHWs deliver high-impact, cost-effective results, even in the toughest times. When care must continue despite challenges that mount and morph, CHWs are often the difference between continuity and collapse.

For Community Health Impact Coalition (CHIC), this changing context sharpens — rather than softens — our role.

WHAT THIS MEANS FOR THE PROCHW MOVEMENT.

Global norms are no longer the finish line: In a fragmented landscape, progress will increasingly move through regional blocs, coalitions, and aligned country groupings rather than universal consensus alone. Global norms can provide leverage to get there — but on their own, they are not enough.
Position proCHWs as resilience infrastructure: proCHWs are not an add-on to health systems. They are core delivery infrastructure — essential to building durable state capacity and maintaining essential services through shock and stress.
Continue to own the truth in an era of spin: Beginning in 2026, CHIC’s proCHW dashboard will track not only whether countries have adopted policies, but whether those policies are actually implemented — and whether minimum standards for proCHWs are being met in practice.
Refuse performative compliance: We must continue to name the truth: a strong and lasting health system pays and equips its frontline workforce.

As countries navigate a more volatile global landscape, the question is no longer whether health systems should be resilient, but how that resilience is constructed in practice.

A strong and lasting health system pays and equips its frontline workforce. Anything else is a false economy — and a risk health systems can no longer afford.