The Case for CHWs: Champions of the Health System.

Community health workers (CHWs) are trusted members of the community. Laypeople who have received organized training to provide healthcare services to neighbors. A link between the health system and individuals.

CHWs provide reliable information, carry out health promotion and prevention activities, implement vaccination campaigns, and treat illness. Rigorous research indicates CHWs can do all sorts of complex health tasks. Such as delivering birth control injections or HIV care management. And CHWs can ultimately reduce the level of sickness and number of deaths through their efforts.

CHWs are often the first point of care for vulnerable and underserved populations in low- and middle-income countries (LMICs). It has become increasingly apparent that CHWs are not a second-rate stop-gap. Not a quick, second-class response to the challenge of providing health services for those in poor countries who need them. Instead, CHWs are essential to realizing a first-class health system worldwide. Because CHWs can make it possible for all people to receive the vital services required for optimal population health. CHWs stay in their communities for the long term—contributing to transformative health effects.

We will always need CHWs going door to door providing care to their neighbors. This workforce is not a nice to have.

By 2030, the World Health Organization (WHO) estimates a global shortfall of 10 million health workers. CHWs are poised, ready, and key to filling the gap.

We know CHWs work. Just some of the notable achievements by CHW programs in recent history include:

• Maintaining speed and coverage of community-delivered care in many LMIC during the COVID pandemic.
• Addressing up to 50% of the malaria burden in countries across the globe.
• Since 2004, CHW involvement in HIV programs helped save an estimated 100 million children’s lives and cut AIDS-related deaths by 60%.
• Playing a crucial role in ending the 2016 Ebola epidemic.  

Deploying CHWs who consistently provide just 30 life-saving health services in countries with the highest disease burden would save as many as 6.9 million lives annually. And reduce child mortality by almost half.

CHWs have played a vital role in many global health efforts. For example, CHWs were among the frontline health workers at the forefront of U.S. investments in HIV from 1990 to 2015. Since 2004, CHWs helped save an estimated 100 million children’s lives and cut AIDS-related deaths by 60%.

Research shows CHWs improve maternal and child health services, expand access to family planning, and support prevention and care for noncommunicable diseases. CHWs greatly enhance access to care for infectious diseases such as HIV and tuberculosis. Deploying CHWs who consistently provide just 30 life-saving health services in countries with the highest disease burden would save as many as 6.9 million lives annually. And reduce child mortality by almost half.

Meanwhile, in many countries, CHWs address up to 50% of the malaria burden. In multiple areas, CHWs maintained speed and coverage of community-delivered care during the COVID pandemic.

Governments can generate up to a $10 return for every dollar invested into CHWs. This massive ROI accounts for three factors:

• Increased productivity from a healthier population
• Avoiding the high costs stemming from health crises
• The economic impact of increased employment

Government healthcare systems can also make immediate savings from reduced spending on treating preventable diseases. As such, CHWs have recently moved into the global health policy and practice mainstream.

In the resource-constrained global health environment, the attractive return on investment (ROI) for CHWs makes a compelling case for advancing the proCHW movement. However, there is one caveat on the ROI from CHW programs. To be effective, CHWs must be set up to succeed.