Strengthening Africa’s community health programmes

In 2017, African Union heads of state pledged to deploy two million 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 six million 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 health care 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 health-care services. The results speak for themselves. Liberia’s 4,000 CHWs now deliver nearly 50 per cent 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 Program, 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 $4.4 billion 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 coordinate resources and technical expertise to reduce the bureaucratic burden.

To that end, the Africa Centres 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.