UNITED NATIONS GENERAL ASSEMBLY 81.

PROCHW MOVEMENT AT UNGA81

THE FUTURE OF COMMUNITY HEALTH IS PROFESSIONAL.

“The faultlines in our world are widening. Cracks have become canyons.”

That is how UN Secretary-General António Guterres opened his address to the 81st United Nations General Assembly. In moments like this, the instinct is to retreat to safer bets. Guterres pointed the other way: “The greatest power is not the power to dominate. It is the power to build a future that works for everyone.”

Health for all is part of that future, and professional community health workers (CHWs) are essential to building it.

Across UNGA81, CHWs were central to conversations on maternal and child health, HIV, climate resilience, AI, health security, financing, NCDs, digital health, and more. The range of those conversations reflects the range of their work and impact.

More than 50 countries have adopted proCHW policy. What was once considered ambitious is now the direction of travel for health systems worldwide.

Countries are proving it is possible. The opportunity at UNGA81: adopt, finance, and implement proCHW policy in every country.

If we expect community health workers to carry the responsibilities of health professionals, we have to build systems that treat them as professionals.

Dr. Sheila Davis, CEO, Partners in Health

COALITION UNGA SIDE EVENT

ADOPTING, FINANCING, AND IMPLEMENTING PROCHW POLICY IN EVERY COUNTRY.

On September 21, Community Health Impact Coalition (CHIC) convened ministers, CHWs, funders, and global health leaders to discuss what it will take to make professional CHWs the norm in every country.

Thank you to the leaders who shaped the discussion:

Dr. Sheila Davis — CEO, Partners In Health
Dr. Rindang Asmara-Petersen — CEO, 1000 Days Fund
Carmen Rosa Vilela Vargas — CHW, Peru
Margaret Odera — CHW and Advocate, Kenya (moderator)
Hon. Khaité Sall — Minister of Health and Public Hygiene, Guinea
Mary Muthoni Muriuki, CBS — Principal Secretary, State Department for Public Health and Professional Standards, Kenya
Dr. Youssouph Tine — Director General of Health, Ministry of Health and Public Hygiene, Senegal
Dr. Sania Nishtar — CEO, Gavi, The Vaccine Alliance
Julia Martin — Head of Strategy and Policy, The Global Fund
Helga Fogstad — Global Health Director, UNICEF
Dr. Madeleine Ballard — CEO, Community Health Impact Coalition

For too long, conversations about CHWs have happened without CHWs. This year, a CHW moderated the panel.

“Every day, I see what happens to these decisions once they leave rooms like this. I’m often answering questions on panels like this. So it’s nice to turn the tables this morning.” Margaret Odera, CHW and Advocate, Kenya

THE MOVEMENT'S SCOREBOARD.

For the first time, the proCHW movement arrived at UNGA with a tool to track progress—and advance it.

The Coalition’s proCHW Policy Dashboard 2.0, launched this spring, tracks where countries are across adoption, financing, and implementation. It shows which countries have proCHW policy—and the conditions that determine whether it reaches CHWs: domestic financing, budget lines, costed plans, salaries, training, supervision, supplies, and integration into national systems.

Each year, 10 to 15 countries reach a policy window as their national community health policies come up for renewal. Senegal is in one now. Guinea already has proCHW policy, with financing a key next step. Kenya is further along, with proCHW policy at national scale and implementation indicators showing where there is still work to do.

USE THE DASHBOARD

FROM COMMITMENT TO PAYCHECK.

ADOPT.

Senegal could be the next country to adopt proCHW policy.

The country is rewriting its national community health policy now, with legal status, career pathways and social protection, and sustainable financing all on the table.

Dr. Youssouph Tine, Director General of Health, pointed to the limits of the current model:

“Volunteering has shown its limits.” Translated from French

For Dr. Tine, the next milestone is moving Senegal’s policy reform toward a financed national model for professional CHWs.

For Baytir Samba, President of ROCBACS Senegal, the reform is an opportunity to address what CHWs have been organizing around for years. Representing a network of more than 44,000 members, Samba called for a community health workforce with formal status, sustainable salaries, social protection, and a defined place in Senegal’s health system.

HEAR DIRECTLY FROM BAYTIR

Another country approaching a policy opportunity is Peru. CHW Carmen Rosa Vilela Vargas described how CHWs are organizing to turn recognition into policy change. Over the past year, they have taken their demands to the Congressional Budget Commission and political groups across the spectrum, while CHW groups in several regions have organized to secure legal recognition.

In Indonesia, Dr. Rindang Asmara-Petersen, CEO of 1000 Days Fund, described a workforce of 1.5 million CHWs who are still called volunteers.

FINANCE.

Guinea has proCHW policy. Sustainable financing is the next step.

Honorable Minister Khaité Sall described moving its community health workforce from individual projects into a nationally owned system. Guinea is integrating CHWs into primary care, mapping the workforce nationally, connecting CHW data to the national health information system, and using its legal framework for local civil services to create a pathway for integrating CHWs into the workforce.

Sall was direct about the work ahead: greater government investment in CHW salaries and treating the people delivering care in communities as an investment, too.

Global financing institutions also put commitments on the record.

Dr. Sania Nishtar, CEO of Gavi, the Vaccine Alliance, singled out proCHWs as a priority. “If there was just one event and one issue that I would lend my voice to this week, it would be this one.”

Gavi has incorporated CHW remuneration into its health systems policies and supports CHW salaries when governments request it as an interim step toward sustainable domestic financing. Gavi has also mandated digital CHW payments to improve traceability.

The Global Fund‘s Julia Martin focused on what external financing can help countries build: a national vision for the community health workforce, backed by the costing, workforce planning, roles, and responsibilities needed to make it sustainable. Her goal is more countries moving from policy to a workforce where the CHW position is defined, formalized, and recognized.

UNICEF‘s Helga Fogstad called for financing that strengthens rather than substitutes for national systems, better alignment among partners, and government-owned training linked to career pathways.

And the money is already flowing. Africa Frontline First, co-created by the Coalition, the Financing Alliance for Health, and Last Mile Health, under the championship of former Liberian President H.E. Ellen Johnson Sirleaf, partners with governments, donors, doers, and regional institutions to drive smarter, more effective financing for CHWs and build a stronger future where every community has access to quality healthcare. To date, AFF has unlocked $254+ million from multilaterals and philanthropy to invest in CHW registries, supply chains, training, supervision, and delivery systems. This includes a Catalytic Fund designed with the Global Fund, Skoll Foundation, and Johnson & Johnson Foundation.

Community health workers are no longer simply an actor attached to individual projects. They are progressively becoming an integral part of our primary care system.

Hon. Khaité Sall, Minister of Health and Public Hygiene, Guinea

IMPLEMENT.

Kenya has proCHW policy at national scale, working toward full implementation.

More than 100,000 community health promoters are serving communities across Kenya. Principal Secretary Mary Muthoni Muriuki described what the government is putting behind that workforce: stipends, government-paid health insurance, digital tools, training, supervision, supplies, and equipment.

“Adopting a policy is only the beginning. Sustainable financing and disciplined implementation are what turn political commitments into a functioning community health system.”

“The stipend alone is not professionalization,” Kenya’s national and county governments now share responsibility for stipend payments and insurance. “We must move from policy to 100% implementation.” That includes moving beyond pilots and bringing government, development partners, and the private sector into a shared financing approach rather than operating in silos.

FROM HEARST TOWER TO THE UN GENERAL ASSEMBLY.

Dr. Sania Nishtar, CEO of Gavi, the Vaccine Alliance, called for the conversation to move to the UN itself.

“It’s not just the 44th floor of the Hearst Tower, but the United Nations General Assembly where a high-level session needs to be held as well.”

The UN has held high-level sessions on NCDs, tuberculosis, and pandemic prevention, preparedness, and response. Nishtar’s call: put the community health workforce on that agenda, too—and hold decision-makers accountable for progress.

THE BLOOM.

Dr. Madeleine Ballard, CEO of Community Health Impact Coalition, closed the morning with a story from Death Valley.

The hottest, driest place in North America is full of seeds. Most years, the conditions aren’t right for them to grow. This year, Death Valley saw its biggest wildflower bloom in a decade. The seeds had been there all along. The conditions changed.

Community health workers were unpaid volunteers for a century. They had the skill. The evidence was never thin. Yet health impacts failed to bloom nationally. Good seed. No storm.

At Community Health Impact Coalition, we built the storm: the guidelines, funding, and policy that turn professional CHWs from isolated programs to national success stories.

More than 50 countries now pay and accredit professional community health workers. The opportunity now is every country. Join the movement.

We are winning more than we have ever won, in a harder period than we have ever faced.

Dr. Madeleine Ballard, CHIC, CEO