New Report Highlights Benefits from Investments in CHW Programs

A high-level report released at the Financing for Development Conference finds that community health workers can save 3 million lives per year, stop future epidemics and create employment.

Joint Release from Partners in Health, Last Mile Health, and the UN Secretary General’s Special Envoy for Financing the Health MDGs and for Malaria

ADDIS ABABA, Ethiopia
A report released this week at the Third International Conference on Financing for Development found that there is a strong case for investing in Community Health Worker (CHW) programs as part of integrated health systems. The report, “Strengthening Primary Health Care through Community Health Workers: Investment Case and Financing Recommendations” —was released by leaders from the Federal Democratic Republic of Ethiopia, the Republic of Liberia, the U.N. Secretary General’s Special Envoy for Financing the Health MDGs and for Malaria, Partners in Health, the Clinton Foundation, the African Leaders Malaria Alliance, and the MDG Health Alliance. The authors encourage domestic governments, international financers, bilateral and multilateral donors, and the broader global health community to finance and support the scale up of CHW programs as part of community-based primary health care through a set of specific recommendations.    The authors participated in the crafting of the report and its recommendations as part of a distinguished panel chaired by Ray Chambers, the UN Secretary General’s Special Envoy for Financing the Health MDGs and for Malaria, and Prime Minister Hailemariam Dessalegn, President of the Federal Democratic Republic of Ethiopia.

The report follows Monday’s launch of the Global Financing Facility (GFF) in support of Every Woman Every Child by the World Bank Group, Canada, Norway, the United States and country and global health leaders, with the goal to end preventable maternal and child deaths by 2030. At the launch, the World Bank Group announced a new partnership with its International Bank for Reconstruction and Development to raise funds from capital markets for countries with significant funding gaps for reproductive, maternal, newborn, child and adolescent health. This groundbreaking partnership expects to mobilize between $3 to $5 dollars from private capital markets for every $1 dollar invested into the GFF, and one of the initial focus areas will be strengthening front-line health systems and building CHW programs. As part of the GFF, the Government of Canada has announced a $40 million investment to be used as performance payments to countries using GFF funding to scale up CHW programs and implement malaria control programs.

“Ethiopia’s Community Health Extension Workers have been essential in our progress to bring healthcare to the poor and marginalized and fight the top killers of mothers and children across our country. We are delighted to co-lead this effort and fully endorse the findings of this report,” said Prime Minister Hailemariam Dessalegn of Ethiopia.

Increasingly, global health leaders view investments in health delivery systems, and investments in community-based primary health care in particular, as essential to meeting global health goals for maternal and child survival as well as for preventing and containing health crises, such as the deadly Ebola outbreak in West Africa that has claimed over 11,000 lives.

“CHWs play the most important and effective role in our fight against disease,” said President Ellen Johnson Sirleaf of Liberia, a member of the Panel, in a speech yesterday at the Third International Financing for Development Conference in Addis Ababa. “It is they who have reached the most vulnerable, they who have been able to be the contract tracer, they who have been able without much training to take the risk to go out into the community and bring care.”

The report highlights that up to three million additional lives per year could be saved by further investing in CHW programs in Sub-Saharan Africa. Analysis in the report finds that CHWs can yield an economic return of up to 10:1 due to increased productivity from a healthier population, a reduced risk of epidemics and through increased employment opportunities. It notes, however, that country-specific return on investment analyses will need to be developed.

“As a businessman and philanthropist, I can think of no better investment in a country’s health system than the deployment of armies of community health workers,” said Ray Chambers, the UN Secretary General’s Special Envoy for Financing the Health MDGs and for Malaria.   “I hope that all nations – in developing and more developed economies – take a hard look at these findings and act quickly to implement the recommendations.”

The authors found that CHW programs should strive to maintain ten core principles in their design and a focus on performance management, and that additional financing should be linked to adherence to these principles.

Finally, the report calls on governments and the global health community at large to build teams that can support countries in defining a financing pathway and in accessing domestic and global financing sources.

In reviewing what it would take to finance community health systems, the report’s authors came the following key findings:

• There is a strong case for investment in CHWs, since they will be essential for achieving Universal Health Coverage and for complying with the core capacities of the International Health Regulations. Scaling up CHWs would lead to expanded access to health care that could save up to 3 million more lives each year. Investing in CHWs across sub-Saharan Africa has the potential to yield an economic return of up to 10:1 given increased productivity and employment, and from a healthier population
• While each country’s context will be different when building CHW programs, countries should strive to adhere to ten core principles, which include addressing program leadership, integration into the health system, engaging communities, securing financing, including incentives, building monitoring capacity, and ensuring sufficient health worker training. Importantly, CHWs should not be considered a ‘stand-alone’ solution but as part of the broader integrated primary care health system. Referral pathways should be well-defined and substantial investment should be made in supportive supervision.
• Though there is financing for CHWs today, countries must be proactive in how they assemble a financing pathway for their system – determining the required program scale, costing the plan, setting financing targets and identifying specific financing mechanisms to reach these targets.

The report also provides specific recommendations to several groups of stakeholders:

• To government leaders in sub-Saharan Africa, the report encourages the development of country-specific investment cases and return on investment analyses and prioritize domestic investments in CHWs. The report urges governments to proactively seek innovative financing arrangements with funders and to build strong teams in your countries to define, structure, and negotiate financing pathways.
• To the international financing community the report recommends making low-cost, performance-based debt financing available to countries aiming to scale up CHW programs.
• To bilateral and multilateral donors, the report urges the use of disease-specific funding to be used for integrated CHW plans.
• To the global health community broadly, the report recommends consideration of establishing a unit or team to support the country-specific ‘deal teams’ to access available financing options and build best-practice CHW systems. Additionally, the report encourages the development of metrics for effective CHW program implementation that could guide financing support and to consider creating a scorecard that could add transparency on CHW program impact.

Today, there are several hundred thousand Community Health Workers promoting health and providing treatment to patients across Sub-Saharan Africa. The report’s authors, in keeping with earlier estimates from the One Million Community Health Worker’s Campaign, recognize that several hundred thousand more CHWs are needed to close health access gaps. Nearly 40% of newborn and child deaths globally are due to malaria, pneumonia, diarrhea, and newborn sepsis, which are, and have been proven to be, diseases that CHWs can easily and affordably prevent and treat.

Further commentary on the report is available on the Huffington Post from Jeffrey Walker, Vice Chair of the MDG Health Alliance, and from Raj Panjabi, CEO of Last Mile Health.