Funding for community health workers moves up the agenda

The 3rd International Symposium on Community Health Workers has ended with the Monrovia Call To Action, a commitment to fund, scale and strengthen community health programmes as part of primary healthcare. 

What is this story about? 

Action being taken to strengthen community health programmes. It has come out of the International Symposium on Community Health Workers which happened in Monrovia, Liberia at the end of March. Over 700 participants attended the event, including government ministers and high-level representatives from 46 countries, international donors and community health workers. 

It ended with the Monrovia Call To Action, a call for governments, donors and others to train, pay, adequately supply and support community health workers (CHWs). 

Why is this important? 

CHWs come from (or are linked to) the communities they serve. They have less training than nurses and doctors. But they are often able to reach people that other health professionals can’t because they are known and trusted. Their efforts also reduce the workloads of other health staff, which makes health services more efficient. But despite their contribution, CHWs are often undervalued, underpaid and underutilised.  

What is happening? 

The Monrovia Call To Action states that CHWs are key to achieving universal health coverage. This is a sustainable development goal target that aims for everyone to have access to safe, effective, quality and affordable healthcare, medicines and vaccines.  

But it says that, in low- and middle-income countries, around half of CHWs are unpaid. Often, CHWs don’t have the medical supplies they need to do their job.  

To improve things, the Monrovia statement calls on heads of state, government ministers, the African Union, Africa CDC, international partners, the United Nations, civil society and the private sector to commit to the following five actions: 

Action 1: Invest in country-led community health strategies 

There is a need for clear, costed and prioritised community health strategies that take equal access into account. Domestic and private sector funding for primary healthcare and CHWs needs to increase. Out-of-pocket spending for patients needs to decrease. 

Action 2: Make professional community health workers the norm 

In line with the WHO guidelines, CHWs should be paid fairly. They should be skilled, supervised and supplied to deliver high quality care. They should get opportunities for career progression. Most CHWs are women. So these changes should happen in a way that protects CHW jobs for women and other people from marginalised groups.  

Action 3: Integrate community health workers into human resource and health sector plans 

CHWs should be recognised as a core part of primary healthcare systems. This starts with counting and accrediting CHWs. CHWs should also be included in decision making. 

Action 4: Galvanise political support 

There is a need for advocates to champion community health programmes to put the issue on global, regional and national agendas. There is a need to develop an ‘investment case’ (evidence on the benefits of investing in CHWs).  

Action 5: Track progress on community health programmes  

There is a need for an agreed framework to track progress on strengthening community health programmes. This should be developed in consultation with CHWs and others. 

What does this mean for HIV services? 

A call for more investment in CHWs is good news for HIV and sexual and reproductive health services. For years, the HIV response has been championing community-led responses. This is based on evidence gathered over decades that people from the communities most affected by HIV know best what they need, and are well placed to deliver it.  

This could open up opportunities to push the community health agenda forward. There is also a need to track what this call leads to and to act accordingly. For example, making sure community health programmes recruit CHWs from a diverse range of backgrounds, including people who are criminalised. This is key to ensuring community health programmes reach all those who currently struggle to access essential health services.  

You can suggest changes or additions to the Monrovia Call to Action until 7 April by emailing info@chwsymposiumliberia2023.org.