"Strong Community Health systems in every community are critical for providing accessible, quality and cost-effective preventive and treatment services, including during emergencies".
These were the words echoed by Dr Jean Kaseya, Director General for the Africa Centres for Disease, Control and Prevention (Africa CDC) at a high-level side-event on Community Health Workforce, Systems and Programs in Africa. The event was held at the margins of 76th World Health Assembly in Geneva, under the theme: What will it take for effective institutionalization and sustainability?
The event was hosted by the African Union Commissioner for Health, Humanitarian Affairs and Social Development, Her Excellency Ambassador Minata Semate Cessouma, to build momentum on the integration of Community Health Workers (CHW) programmes into national human resources for health planning, policy, and management; second, to elevate the political voice and prioritization to extend health system reach to subnational and community levels in Africa; and third, facilitate inter-country support mechanisms on the South-to-South Cooperation between Member States to strengthen, institutionalize and sustain Community Health Programs.
Ambassador Semate Cessouma underscored that during the 29th AU summit in July 2017, the Heads of States and Governments endorsed the 2 million CHWs initiative decision, and urged the Commission to collaboration with partners to rapidly recruit, train and deploy 2 million CHWs across the continent. "Building and maintaining a robust public health workforce across countries' health systems aligns with the African Union's (AU) Agenda 2063: The Africa We Want, which endorses health as a cornerstone agenda for achieving longer- term development goals"
The high-level remarks and panel discussions involved Ministers of Health and officials from WHO, IFRC, UNICEF, UNAIDS and a Community Health Worker representative. They called on AU member states to build along the challenges and opportunities for institutionalising and domestication of financing CHW programmes in Africa, where over a billion people cannot access health services they need, because the services are either unavailable or unaffordable.
Dr Jean Kaseya reiterated on the lessons from the Ebola Virus Disease (EVD) outbreak in West Africa (2014-2015) and the recent COVID 19 pandemic, emphasising the importance of community health workers in the provision of basic health services at community level but also in supporting public health emergency preparedness and response.
"A 2021 report showed that there is US$ 2 billion funding gap annually for a fully scaled and integrated CHW system in sub-Saharan Africa. However, the same report indicates that for each dollar invested in community Health, there is 10 dollars return on investment. Therefore, addressing the challenges of health workforce availability is therefore critical to progress toward sustainable development goal (SDG) 3, including universal health coverage and beyond to health equity", he said.
A recent survey conducted by Africa CDC to understand the landscape of community health workforce, program and system in Africa reveals that:
- There are inadequate National Community Health programs financing and sustainability, where only 21% of 42 Member State that participated in the survey have a community health worker investment case and only 26% have a budget line for payment of CHWs.
- There are gaps in community health information system where 71% of countries are still using paper-based data collection system and 32% don't integrate CHW data in human resources for health information systems.
- Gaps in Community health policies and guidelines where only 55% of countries have costed strategic plan and 18% don't have the plan at all among other challenges.
In his statement, Xavier Castellanos, Undersecretary General of the IFRC said "If communities do not hear their voices they trust, they will not go along with public health efforts, no matter how well intended. While many voices will be needed to achieve this, the voices of community health workers are critical".
"Community Health Workers are truly the equity arm of primary health care. UNICEF commended African Union (AU) and Africa CDC for sustaining momentum towards the 2 million community health workers initiative and for establishing the continental coordination mechanism for community health programs. Investing in Community health workers offers a significant long-term return on investment, driven by increased productivity from a healthier population, avoidance of future global and public health crises or pandemics, increased employment, and women's economic empowerment - tackling gender-based inequities. This isn't just right - it's also smart; it's a smart and tactical investment," said Ted Chaiban, Deputy Executive Director, UNICEF.
The data exposes the critical need to strengthen support in the development and implementation of coherent national policies; education and training matched to jobs and population health needs; standard operating procedures; and guidance on integrated community health service delivery, using the WHO CHW Guideline recommendations adapted to national context and service delivery requirements. Progress - and success - rely on political prioritization and sustainable resource allocation. Advocates at all levels have a role to play in promoting and accelerating this high level commitment.
"Africa bears 25 per cent of the global burden of disease, yet has only 4 per cent of the global health workforce. Urgently, we must tackle health worker shortages and maldistribution," stated Bruce Aylward, WHO Assistant Director General. "WHO's priority over the next five years is to radically reorient towards primary health care, including honouring, respecting and championing the health workers who deliver it. Community health worker programmes must be integrated as part of national health workforce planning, systems and policies, including strengthening education, offering decent work with fair pay, and reinforcing linkages with other health workers. It's time to break the silos and for all of us to stand behind one national plan, led by countries. WHO is with you as we protect and invest together in the health workers who are the cornerstone of equity and Health For All."
Sign up for free AllAfrica Newsletters
Get the latest in African news delivered straight to your inbox
"Community health workers play a critical role in decreasing inequalities--by reaching those with the most health disparities and most challenges accessing care even in the best of times. CHWs and community groups bridge the vulnerable with health settings, work with other cadres of the health system to ensure health services at gross root level to deliver primary health care which as a backbone of Universal Health Coverage",Dr. Angeli Achrekar, UN Assistant Secretary General and UNAIDS Deputy Executive Director.
In its efforts to support CHW systems and programmes, Africa CDC has thus far supported the local recruitment, training and deployment of over 29000 community health workers across 29 AU Member States for contact tracing, active case search, risk communication and community engagement (RCCE) and in facilitating referrals. This has been done through the partnership to accelerate COVID 19 testing in Africa (PACT) initiative and more support to member states are underway.
Africa CDC assured its commitment to spearhead and take a lead in implementing the programmes as mandated by its member states, and urged all partners to work together in a coordinated manner, and actions towards institutionalising community health workers for longevity across political cycles, and establish a continental coordination mechanism for Community Health in Africa. The event brought together 227 Participants from 34 countries and 5 continents.
