It's the water. - Community Health Impact Coalition

DR. MADELEINE BALLARD, CEO, CHIC

On the eve of the UNGA 78 we reflect on what’s changed.

David Foster Wallace famously told the story of two young fish who pass an older fish swimming the other way. The older fish says, “Morning boys! How’s the water?” One of the younger fish turns to the other and says, “What the hell is water?” Community Health Impact Coalition is changing the water.

The Coalition exists to make professional CHWs the norm worldwide by changing guidelines, funding and policy. Before any guideline change, or funding boost, or policy win comes a change in the water.

In 2019, the year the Coalition was founded, I was at an event hosted by a major New York City philanthropy during UNGA. CHWs were discussed, yet none were present. The President of the foundation noted that the initiative under discussion was so cheap because “a lot of the CHWs are not even paid!” The head of a major global health initiative later chimed in, “the health workers weren’t paid for two years…that’s what helped us get here!”

Let it be noted that neither of these individuals would utter such statements today. Instead, in the last year, the following people have gone on record saying the opposite:

Peter Sands, The Global Fund

“Frankly, if we paid, trained, equipped, and had more community health workers, it’s probably the single most powerful lever we could pull”

Dr. Seth Berkley, GAVI The Vaccine Alliance

“Many countries pay community health workers very little — or don’t pay them at all — which is a dangerous move”

Dr. Mohammed Abdulaziz, Africa CDC

“We heard very clearly from member states that CHWs cannot be voluntary, they must be compensated. They should be protected with PPE and have career advancement opportunities”

changing the waters.

In four short years since founding the Coalition we have made the idea of unpaid CHWs obsolete. Never mind the idea of talking about CHWs without CHWs in the room.

“People don’t brag about not paying CHWs – how cheap it is for the health system – anymore. I won’t say this in public, but I will lay a boatload of that at CHIC’s lap”
WHO Official

Norm change is notoriously hard to measure. As a Coalition, we don’t count or report standard metrics like patients served or CHWs trained. Instead we track proCHW guideline wins, proCHW funding increases, and proCHW policy changes.

We’re serious about change and hold ourselves to a high standard. And we’re winning.

But we’d be remiss not to mention that some of the most important shifts are the hardest to measure – even though they end up being the most concrete of all.

“Since I met CHIC, I have more courage and zeal for what I’m doing. CHIC makes us understand that we are valued in society as CHWs. The Coalition inspired me to do more. CHIC is a hope giver.”
CHW

If you’ve ever heard “85 percent of Africa’s CHWs are unsalaried” – that’s CHIC. If you’ve ever heard “CHWs are out of stock one third of the time” – that’s CHIC. If you’ve ever heard “CHWs maintain health services during pandemics” – that’s CHIC.

So this year, at UNGA, we’re doubling down. We’ve already put professional CHWs in the spotlight; now it’s time to make them the standard.

Resource Library.

Pay CHWs.

Despite their vital work CHWs have long been subject to global debate about remuneration. But the discussion should move on to how to pay CHWs, not whether they should be paid.