In 2017, African Union Heads of State and Government made a strategic commitment to strengthen the health workforce by training and deploying two million community health workers to help close the gap in healthcare provision.
Eight years down the line, Africa has managed to deploy half of the intended target. Preliminary findings from the Continental Survey on Community Health Worker Programmes—conducted jointly by Africa CDC and UNICEF and released on the sidelines of the 78th World Health Assembly in May—show that progress is being made.
“We have 1,005,007 community health workers already deployed. That means we have achieved 50% of the target in just eight years,” said Dr Ngashi Ngongo, Principal Advisor to the Director General of Africa CDC and Continental Incident Manager for the Mpox response in Africa.
“What lies ahead is that, in the remaining five years, African Union Member States need to recruit, train, and deploy the remaining one million. That’s why it is important for this survey to be conducted annually until 2030 to track progress,” he added.
“The big question is: what needs to change to shift the needle from the one million community health workers we currently have to the two million-plus required? In 2017, the population of Africa was around 1.1 billion. Today, we are 1.5 billion,” said Dr Raji Tajudeen, Acting Deputy Director General and Head of the Division of Public Health Institutes and Research.
“There is the potential to save 151 million lives, including 5.8 million stillbirths and 4.7 million post-neonatal under-five deaths. These lives could be saved by building strong systems. So, it’s literally about saving the most vulnerable,” said Dr Yasmin Ali Haque, Global Health Director for UNICEF.
Africa CDC and UNICEF surveyed all 55 Member States of the African Union through a structured questionnaire, which was posted online and sent to focal points in each Ministry of Health. Fifty-one countries responded.
A community health worker is defined as someone selected and accepted by the community; recognised, trained, remunerated, equipped, supervised, and deployed to perform a well-defined scope of work within the national minimum package of services, as determined by Member States.
Public health experts examined seven key domains of community health systems: governance and policies, financing, workforce, service delivery, community supply chain management, health information systems, and community engagement.
The Africa CDC and UNICEF research reviewed the existence of policies and strategies on community health, coordination mechanisms and partnerships, performance review systems, analysis of bottlenecks, and recommendations for improvement.
“We now know how many community health workers are out there. For 46 Member States—including the big ones like Nigeria, Ethiopia, and the Democratic Republic of Congo—with a combined population of nearly 1.3 billion, the data is available,” said Dr Ngashi.
An analysis of the workforce density showed that there are approximately seven community health workers per 10,000 people—equivalent to one community health worker for every 1,235 individuals.
Regarding gender, Dr Ngashi noted that while literature tends to suggest 70% of community health workers are female, only 21 Member States reported data on this indicator—and key countries like Nigeria, Ethiopia, and DRC did not submit gender-disaggregated data.
Positive findings also emerged on policy and regulatory frameworks: around 80% of countries surveyed have a national community health strategy, and 63%—two-thirds—recognise community health workers as an integral part of the national health workforce. “It is reassuring that Member States are starting to integrate community health workers as a key component of their health agendas,” said Dr Ngashi.
He also noted that the scope of services delivered by community health workers is expanding in many countries—from maternal and child health to integrated management of childhood illnesses, as well as endemic diseases like HIV, malaria, and tuberculosis, and increasingly, non-communicable diseases and public health emergencies.
“I think most of the package is there, but in future, we need to assess what proportion of workers in each country deliver the full package compared to those focused only on vertical programmes,” he said.
He added that it was encouraging to see 92% of Member States have a national standardised training curriculum. “This is very encouraging progress. We are moving in the right direction,” said Dr Ngashi.
Four out of five deployed community health workers have received training. At least 69% of Member States have community-based data integrated into the national health information system, and 63% have a master list identifying where community health workers are deployed.
“But a weakness is that only 25% of Member States offer a formal career path or opportunities for advancement. That is something that also needs to be addressed,” he observed.
In terms of financing, 61% of Member States have included some community health activities in their national budgets—covering training, salaries, deployment, and other recurrent costs. “The reality is that recurrent costs should be the responsibility of governments. Partners may support temporarily, but they cannot sustain programmes indefinitely,” he said.
With external funding cuts, researchers anticipate that community health programmes in 38 countries could be severely affected. “That is of great concern to all of us,” he added.
While 49% of Member States have allocated government budgets to pay community health workers, the remuneration varies widely—from as little as $10 to as much as $300 per month, with a median of $50.
“In the current context of global health funding cuts, there is a lot at stake. Hundreds of thousands—potentially millions—of lives in the fight against AIDS, tuberculosis, malaria, and other health threats are at risk. Community health workers are at the centre of this effort, doing their best to ensure that even the most marginalised populations have access to life-saving services,” said Marijke Wijnroks, Head of the Strategic Investment and Impact Division at the Global Fund, speaking on behalf of the organisation. Alex de Jonquières spoke on behalf of Gavi.
“We must be united and work together to maintain investments in community health workers and strengthen community health systems. We must do better to align with national plans, accelerate progress on integrating community health workers into national health systems, and transition responsibly towards sustainable domestic financing,” said Wijnroks.
The current three-year Global Fund cycle is investing over US$900 million in community health workers and strengthening community health systems through grants to countries. “Our investments are aligned with national plans and the African Union–Africa CDC vision for the continent, complementing domestic financing and the efforts of other partners to ensure community health workers are well trained, supervised, remunerated, equipped, and integrated into the broader health system, working side by side with other health professionals,” said Wijnroks.
