Rosemary Wanjiru is a community health volunteer in Kenya. Hanna Belayneh is a policy and advocacy officer at Results Canada.
Rain or shine, I have been walking the narrow alleyways in my neighbourhood in Nairobi, Kenya, for the last 18 years, offering life-saving treatment and education about HIV and TB to the people who need it the most.
And I am not alone. In many countries around the world, lay health workers selected by and trained to work in their communities are making health care accessible to millions of people every day. From Haiti’s accompagnateurs to Uganda’s Village Health Team workers, to Bangladesh’s Shasthya Shebika, community health workers (CHWs) are trusted neighbours with one mission: offer compassionate care right at the doorstep of those who are often left behind – those who live in poverty and face intricate challenges to access health care, including the high cost of treatment and transportation, distance, and the stigma associated with disease.
As they go door-to-door to visit a patient beginning treatment for tuberculosis to make sure that he takes his medications properly, check on a pregnant woman who is unlikely to access facility-based prenatal care, or vaccinate a child who otherwise may not get immunized, CHWs become bridges that extend the reach of health services well beyond facilities right into homes. Simply put: community health workers are the most efficient and equitable way to expand access to primary health care.
The results speak from themselves. Take Ethiopia: Health Extension Workers – the local community health workers – are widely seen as the main reason why the country has made some of the most notable improvements in health out of all African countries, with significant declines in maternal mortality and in mortality of children under five.
Pandemics, past and present, have brought into sharp focus just how much CHWs can be relied upon in times of crisis. In Liberia, for instance, CHWs were on the front lines of the response to Ebola outbreaks, finding people with disease and tracing their contacts. Now, they are fully engaged in preventing, detecting and responding to COVID-19.
That investing in community health workers yields high returns and is our best bet to expand access to primary health care has been made abundantly clear. Yet, in direct contradiction to this overwhelming evidence, community health workers around the world are underprioritized and under resourced.
With lack of effective integration within health systems structures, CHWs are not always properly identified or recognized as a key part of the health workforce. The vast majority remain underpaid, or altogether unpaid – in Africa, for instance, only a dismal 14 per cent of CHWs are salaried. In essence, most often, community members are shouldering the daunting responsibility of leaving no one behind, while unpaid, with little to no incentive, without adequate equipment, no continuous training and non-existent career prospects.
This defies all common sense, and it must change. CHWs are critical to preventing and responding to health threats and must be supported and paid if they are to be trained and retained.
As we reimagine the future at the 24th International AIDS Conference hosted in Canada this summer, we must make smart and sustainable investments in the people at the front lines who are the very foundation of effective and resilient health systems. The Global Fund to Fight AIDS, Tuberculosis and Malaria – the largest multilateral provider of grants to build resilient and sustainable systems for health, offers us the opportunity to do just that. Recognizing that trained, motivated, equipped and appropriately paid front-line workers are the irreplaceable component of an effective and resilient health system, the Global Fund has been investing vigorously in community health workers around the world for decades.
This year, with a replenishment of at least US$18-billion, the Global Fund would have the resources to step up such investments. If we truly are committed to reducing health inequities and ensuring access to basic health services for all, it is imperative that we rally behind the Global Fund and harness its contributions to community-based systems.
To reimagine a more equitable model for all and prevent the next pandemic, we must not be myopic. We must heed the calls of visionary pioneers such as the late Dr. Paul Farmer, who echoed time and again that there is no more effective tool to address the suffering of those without access to formal health care than deep, lasting accompaniment by trusted neighbours through their journey back to health. The organization he co-founded, Partners in Health, tells us that “injustice has a cure.” Community health workers are the cure.
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