CHIC AT SKOLL 2026.

FROM POLICY TO PAYROLL.

Fifty-plus countries have policies supporting community health workers (CHWs). Far fewer have CHWs who are actually salaried, skilled, supplied, and supervised.

That gap is what brought us to Skoll 2026, a year after CHIC received the Skoll Award for Social Innovation.

The 2025 award arrived at a moment when the global health community had reached a clear consensus: community health workers work. The evidence was in, and governments were moving. Policy adoption followed.

A year later, the conversation has shifted from whether to how. What does it actually take to move from paper policy to salaried, skilled, supplied, supervised CHWs on government payroll?

THE FINANCING FRONTIER.

The clearest shift at Skoll this year: domestic financing, not donor funding, is where durable CHW programs are built.

In our session co-hosted with the Skoll Foundation, From Pilot to Policy: Community Power in Public Systems, two country examples made this concrete—and they pointed in different directions.

In Guinea, ten municipalities pooled roughly $350,000 of their own revenue to put CHWs on payroll. One mayor used market tax income to fund 35 workers serving 25,000 people. The first paychecks go out June 1.

In Côte d’Ivoire, the money is already there. The government covers 51% of CHW costs, but the sector rarely counts it. That undercounting makes genuine government ownership look like donor dependency.

Together, the cases reframe the financing question. Guinea shows that local revenue can be mobilized where none was assumed to exist. Côte d’Ivoire shows that domestic investment is already happening but going unrecorded. There is more money in the system than the narrative suggests. The work now is making it visible, replicable, and politically sustainable.

AI BELONGS INSIDE THE SYSTEM, NOT ALONGSIDE IT

The same implementation pressures are shaping how AI tools are being introduced into community health.

On the sidelines of Skoll World Forum, we convened a working session with CHW-implementing NGOs, technology partners (including Google and Anthropic), and funders on what it takes to move AI beyond pilots and into systems.

The answer kept surfacing: the bottleneck isn’t the technology. It’s who shapes it. CHWs are still rarely involved in designing the tools built for them. Data flows upward but rarely back to the people collecting it. And most AI pilots are still running alongside public systems rather than inside them.

One phrase captured the room: “You can’t AI your way out of a broken system.”

The tools that work are built by people who understand how CHWs actually operate, and designed to strengthen public systems rather than route around them.

As Maureen Akomo Wauda, a CHW from Migori County, Kenya, reflected during the week: “When the system is working well, I feel connected to it… When there is a problem with the system, I feel the gap immediately.”

Maureen Akomo Wauda, CHW, Migori County, Kenya

BUILDING SYSTEMS WITH CHWS.

The conversations at Skoll repeatedly pointed back to the same underlying question: who gets to shape how systems evolve?

Financing decisions, technology design, and implementation strategies are often discussed around CHWs rather than with them. But some of the strongest examples from the week came from places where CHWs themselves were part of shaping policy and operational decisions from the beginning.

That’s the model. As Rakesh Rajani put it at Skoll: “Serekali ni sisi” — Government is us.

Not an institution to lobby from the outside, but a system to build from within.

Over fifty countries have made the commitment. The question now is whether the movement can build what it takes to make those commitments real — paid workers, functional supervision, financing that outlasts any single donor, and systems shaped alongside the people delivering care.

FROM POLICY TO PAYROLL.

BUILDING SYSTEMS WITH CHWS.

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