A movement to achieve health equity by making professional community health workers the norm worldwide

Community health workers have been a global cornerstone of primary healthcare for more than a century and there is plenty of evidence that their work improves health outcomes. Yet, professional CHWs are still the exception and not the norm. The #proCHW movement is designed to confront the widespread issue of CHWs not being salaried, skilled, supervised and supplied. This means that CHWs are exploited and less effective for patients.

CHIC is an audacious, 60-country movement, comprised of thousands of CHWs and dozens of global health organizations, all of which endorse proCHW best practices and are driving our joint work. We exist because community health workers work. Our idea is that radical collaboration spreads good design, driving results faster. This allows us to wield influence on a scale sufficient to change global norms.

Our shared mission is to make proCHWs the norm worldwide by changing international guidelines, increasing global funding and winning national policy. We strive for quality care for all, including those who supply it. Good health only happens if there are good working conditions.

Research has shown that governments can generate a 10:1 return on investment with CHWs, and proCHWs could save 2 million lives annually.

Across my career I’ve seen indisputable evidence that professional CHWs promote health equity in a variety of ways. One is increased effectiveness: When CHWs are well trained and equipped they can provide more effective healthcare services and boost the uptake of the services they offer, leading to improved health outcomes in their communities. Another is improved access: When CHWs are properly integrated into the health system, they can improve access to healthcare for underserved, marginalized and vulnerable populations.

An important point is data collection: ProCHWs play a crucial role in collecting health data from their communities to identify health trends, possible areas of intervention and potentially drive more effective national health policies.

CHWs are trusted by their fellow community members: They share their same cultural practices and this allows them to win the confidence of their neighbors. It is important for CHWs to be integrated into health systems because it allows for stronger collaboration and better coordination of care. For example, a CHW will be more likely to successfully persuade someone to overcome their misconceptions around certain vaccinations, medicines or hospital practices so that the patient can get the care they need. A CHW can work with doctors and nurses to develop comprehensive care plans that address the unique needs of each patient, based on the CHW’s knowledge of the individuals within their community.

Then there is skill diversity: Different team members bring different skills, perspectives and areas of expertise, all of which contribute to quality of care. For example, when a nurse from semi-arid or arid land comes to work in Nairobi they don’t have direct experience of life in urban areas and the challenges faced by the people there. Insights from a CHW would be invaluable to make more informed decisions.

Finally, CHWs provide continuous care, reducing the gaps in healthcare delivery. In many regions facilities are extremely far from the patient’s home so it falls to the CHW to offer follow-up services.

CHIC hopes to achieve the goal of having 40+ low- and middle-income countries adopt proCHW best practices into their national policies, which will ultimately create a world where pro CHWs are the norm and can provide quality care to all those who need it. So far, 34 countries have adopted proCHW policies, so we still have some work to do. We want to equip international policymakers with relevant evidence and also want to influence global financing institutions to increase funding to CHWs. Additional funding would also help us to empower more CHWs through skills and advocacy training, either by equipping them with smartphones and data bundles or by bringing them to a classroom setting.

To me the program is a significant step toward achieving CHIC’s goals, and it aligns with our mission to make proCHWs the norm. It also demonstrates the growing recognition of the importance of CHWs in the healthcare system. In terms of my daily work, I still feel there is a need to continue to advocate for adequate supplies for CHWs, as well as digital tools. We are also advocating to avoid deepening inequality: We applaud the government’s commitment to pay 50% of CHW salaries and are hopeful that county governments, as owners of community health programming, will be motivated to cover the other 50%. As CHIC’s CHW Engagement Lead I am proud to work alongside CHW Advocates across Kenya as they form the first National Association for CHWs. This CHW-led association is best placed to hold the Kenyan government to account and we will support them in this.

CHWs play a critical role in reaching marginalized and underserved populations. Making community health a priority across the world, and in Kenya specifically, will undoubtedly help to bridge healthcare gaps, reduce disparities and ensure all individuals, regardless of their socioeconomic status, have access to quality health services.