A five-year plan for Tanzania requires a total of $360m for a phased implementation of the Integrated and Coordinated Community Health Workers program to advance the achievement of Universal Health Coverage. The first year alone will cost $40m.
The cost was released at a workshop held by Africa CDC from 2 to 6 September 2024 in collaboration with donors and implementing partners who supported the Ministries of Health of Tanzania and Zanzibar in Dar es Salaam to develop their country Community Health Acceleration Plan.
The Integrated and Coordinated Community Health Workers (iCCHE) program seeks to scale up Coordinated Community Health Workers programs to increase countrywide coverage of life-saving interventions, contribute to universal health coverage and end preventable maternal and child deaths by 2030, said Dr. James Matthew Guwani, head of Community Health Division at Africa CDC.
The plan covering mainland Tanzania and the island of Zanzibar runs from 2024-2028. It was launched in 2023 by the Tanzania's Ministry of Health in collaboration with the President's Office-Regional Administration and local government and partners.
The aim of the iCCHW is to provide a framework for aligning efforts, coordinating activities, mobilizing resources and achieving impactful outcomes in the realm of community health delivery services.
The iCCHE program will prioritise, expand, and professionalise the community health workers workforce by deploying 137,294Community Health Workers in 4,263 Mitaa and 64,384 Hamlets countrywide.
"This iCCHW is a top priority in the government's transformation plans which will contribute to the country's vision of a healthy society with improved maternal, newborn, child health, nutrition, sanitation, and a reduction in NCDs (Non communicable diseases), thus contributing effectively to individual and national development," said Dr Ntuli Kapologwe, Director of Preventive Services, Ministry of Health Tanzania.
Dr Kapologwe indicated that health financing should be broad to include issues such as Universal Health Coverage, which currently stands below the 66% average. To address this, effective integration and coordination of Community Health Workers (CHWs) are essential.
Dr. Ntuli encouraged the use of advocacy tools to attract donors and secure additional funding. "Learning from successful models and the progress made in Zanzibar can enhance their resource mobilization efforts," he said adding a disease-focused approach was not ideal for this programme, rather a system-focused strategy would be useful to avoid fragmentation.
Dr Barnabas Kwame Yeboah, a Community Health Specialist at the Africa CDC called for institutionalising, integration and sustainability of community health programs and emphasized the importance of political commitment and leadership at global, continental, and national levels. "There is need for structured support and sustainable financing to maintain effective community health initiatives," he said.
Key recommendations were made to sustain and consolidate the overall gains achieved so far through the implementation of the plan. In Tanzaniahigh-level advocacy meetings with government, funding agencies (new and old) should be held to mobilize resources for the implementation of the Community Health Acceleration Plan.
An investment case should be developed as a tool to guide the resource mobilization efforts and advocacy and include resource mapping to gather resources for the Integrated and Coordinated CHW Program. Fast tracking the roll out of community health workers training for the first three clusters, which amounts to 28,000 community health workers from the ten priority regions must be considered. The Integrated Community Health Service Package and Training Curriculum needs to be revised to facilitate training and deployment of community health workers and a process to develop a comprehensive Community Health Strategy in alignment with the existing national roadmap and priorities for of Tanzania.
Zanzibar will need to continue the roll out of the training program for the 3,000 community health workersand hold high-level advocacy engagements to mobilize resources to procure 3,000 community health workers kits before their graduation.The trained 3000 community health workers will need to be deployed upon completion of the training across Zanzibar.
Dr. Salim Slim, Director of Preventive Service and Health Education at the Ministry of Health Zanzibar said Community Health Workers are a key solution to the shortage of healthcare workers in Tanzania Mainland and Zanzibar.
CHWs were instrumental in advancing antenatal care. Zanzibar is now measles-free due to the dedicated work of CHWs, he said. The first case of measles in Zanzibar was identified by a CHW, underscoring their important role in detection, prevention and response in disease outbreaks. "We provide each CHW with the tools to reach 100 community members," Dr Slim said.
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He called for a collective commitment to meet health goals and address challenges like Mpox, urging the development of robust systems to tackle these issues.
He said Zanzibar's President recently launched a 6-month programme for community health worker recruitment, training and deployment. Dr Slimappealed to partners to contribute significantly for Zanzibar to acquire 3,000 CHWs deployment Kits before the first cohort of CHWs graduate in the next 6 months. Seventy-six participants including Africa CDC staff, ministry of health officials and about 12 different implementing and donor partners attended the meeting. The workshop was a follow up to the Africa CDC-UNICEF country consultation in May in Addis Ababa. Africa CDC has committed to the achievement of the decision of Heads of States and Governments to recruit, train, and deploy 2 million Community Health Workers on the continent, by 2030.
