Strengthening Africa’s community health programmes

In 2017, African Union heads of state pledged to deploy 2mn community health workers (CHWs), recognising their role in advancing health for all. Seven years on, as African leaders prepare to convene in Addis Ababa, we must reflect on our progress. By 2030, Africa will face a shortage of 6mn health workers, making CHWs a key component and a fast solution to bridging the continent’s health needs. Developing resilient community health-worker programmes across Africa has never been more urgent.We have witnessed how disease outbreaks can plunge a country into darkness – and how the power of CHWs can help pull it back into the light. As Liberia’s experience shows, CHWs need adequate resources and financial support to be effective. In the early 2010s, Liberia’s efforts to offer primary healthcare in remote areas faced significant challenges. There was a shortage of health workers, and where CHWs were deployed, they were under-compensated and did not have the necessary equipment or training to deliver the essential care that was so desperately needed. As a result, different community health initiatives run in parallel by the government and other stakeholders failed to have a significant impact on patients – a common problem in many African countries.In 2016, the Liberian government launched the National Community Health Assistant Programme to address these issues and apply the lessons learned from the Ebola outbreak that began in 2014. With proper supervision, adequate salaries, and enough supplies to reach every household in their communities, CHWs were empowered to provide standardised, integrated primary healthcare services. The results speak for themselves. Liberia’s 4,000 CHWs now deliver nearly 50% of all reported malaria treatments for children under five and consistently provide access to health services, even during the Covid-19 pandemic.Programmes that take a similar approach have yielded positive results in other African countries. Since Ethiopia implemented its community-based Health Extension Programme, which has deployed 40,000 community health workers, vaccination rates have tripled and child mortality has fallen dramatically. The experience of these and other countries shows that supporting CHWs and integrating them into national health systems can save lives and create livelihoods. It should serve as a guide for expanding community health services across the continent.A resilient community health workforce is key to overcoming existing and future health challenges in Africa, which currently range from alarming maternal and infant mortality rates to a high burden of communicable diseases. Equally worrying is the escalating climate crisis, which has underscored the urgency of improving access to care and building health systems that can adapt to a changing environment. Increasing the number of CHWs, and ensuring that they have adequate resources, is one of the most cost-effective and sustainable ways to achieve these goals.Unfortunately, a daunting $4.4bn annual funding gap – compounded by fragmented financial flows – continues to slow our progress toward a healthier, safer, and more prosperous Africa. The solution is to adopt a "one plan, one budget, one report” framework, like that used by Liberia and Ethiopia. With this approach, governments outline their strategies for national community health programmes, and partners co-ordinate resources and technical expertise to reduce the bureaucratic burden.To that end, the Africa Centers for Disease Control and Prevention and partners launched the first-ever continental coordination mechanism for community health in November 2023. Encouraging coordination among stakeholders will enable African countries to build effective and efficient CHW programmes to tackle the challenges of high-burden communicable diseases such as HIV, tuberculosis, malaria, and non-communicable diseases, as well as to respond better to emergencies, including epidemics and climate shocks.The Africa CDC remains firmly committed to strengthening the community health workforce, which dovetails with the New Public Health Order – the organisation’s health-security agenda – and the AU’s initiative to deploy two million additional CHWs on the continent. As part of this effort, the Africa CDC has collaborated with Africa Frontline First to mobilise the financing needed to professionalise CHWs. Last year’s Reaching the Last Mile Forum in Dubai was a success on that front: 12 partners committed to accelerating support for professional CHWs. This announcement also included $900mn from the Global Fund over the next three years, 74% of which is earmarked for Africa.The private and public actors in Africa must take coordinated action. As heads of state convene for the AU Summit, we urge them to make the development of an integrated professional community health workforce a top priority.