In 2017, African Union heads of state pledged deploy two million community health workers, aware of the importance of their work in promoting health for all. Seven years have passed and African leaders, who They have met again in Addis Ababa (Ethiopia), they must reflect on progress. By 2030, Africa will face a shortage of six million health professionals, which makes community agents a key component and a quick solution to meet the needs of the continent. Developing programs to make these people resilient has never been more urgent.
We have witnessed how disease outbreaks can plunge a country into darkness, and how the power of community health workers can help bring it back into the light. This is demonstrated by the Liberian experience, which in the early 2010s made a great effort to offer primary medical care in remote areas. There was a shortage of toilets and, where community health workers were deployed, they were not compensated enough for their work and did not have the necessary equipment or training. As a result, the different community health initiatives carried out in parallel by the Government and other stakeholders did not have a significant impact on patients; a common problem in many African countries.
In 2016, the Liberian Government launched the National Community Health Care Program to address these issues and apply lessons learned from the Ebola outbreak that began in 2014. With proper oversight, adequate salaries, and enough resources to reach everyone homes in their communities, community health agents were empowered to provide standardized and integrated primary care services. The results speak for themselves. Liberia's 4,000 community health workers today provide almost 50% of all malaria treatments for children under five, and consistently provide access to health services, even during the Covid-19 pandemic.
Programs adopting a similar strategy have yielded positive results in other African countries. Since Ethiopia implemented its Health Extension Program, which has deployed 40,000 community health workers, vaccination rates have tripled and infant mortality has fallen dramatically. The experience of these and other countries shows that supporting community health workers and integrating them into national health systems can save lives and generate livelihoods. This should serve as a guide for expanding community health services across the continent.
Liberia's 4,000 community health workers today provide almost 50% of all malaria treatments for children under five
A resilient community health workforce is essential to overcome 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 escalation of the climate crisis, which has underscored the urgency of improving access to care systems and creating health systems that can adapt to a changing environment. Increasing the number of community health workers and ensuring they have adequate resources is one of the most cost-effective and sustainable ways to achieve these goals.
Unfortunately, a Alarming annual funding gap of $4.4 billion (just over €4 billion), compounded by fragmented financial flows, continues to slow our progress towards a healthier, safer and more prosperous African continent. The solution is to adopt a “one plan, one budget, one report” framework, such as that used by Liberia and Ethiopia. With this approach, governments design their strategies for national community health programs and partners coordinate resources and technical expertise to reduce bureaucratic burden.
With that objective, the Africa Centers for Disease Control and Prevention (CDC) and its partners launched the first continental control mechanism for community health in November 2023. Encouraging coordination among stakeholders will enable African countries to create effective and efficient community health worker programs to address the challenges posed by high-burden communicable diseases such as HIV, tuberculosis and malaria, as well as non-communicable ones, and respond better to emergencies, including epidemics and climatic adversities.
Africa CDC remains strongly committed to strengthening the community health workforce, which is coupled with the New Public Health Order —the organization's health security agenda—and the initiative of the African Union to deploy two million additional community health workers on the continent. As part of this effort, CDC has collaborated with Africa Frontline First to mobilize the necessary financing for the professionalization of these people.
He Reaching the Last Mile Forum which took place last year in Dubai was a success on that front: 12 members they got engaged to accelerate the support of professional community health workers. This announcement also included $900 million from the Global Fund over the next three years, 74% of which is earmarked for Africa.
Private and public actors in Africa must take coordinated action. Heads of State who have met at the AU Summit must consider the development of a community-based, integrated and professional health workforce as a top priority, with clear metrics of success that allow data and evidence to be shared with States member. This will foster a culture of continuous learning and standardization of community health worker programs across Africa.
Community health is the key to making Africa more prosperous and healthier. We must seize the opportunity to train and deploy a robust corps of community health workers.
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