The One Million Community Health Workers Campaign: Accelerated Scale Up
Patrick Yao Tang, MPH
Jeffrey Sachs, Director of The Earth Institute at Columbia University, is campaigning to raise one million community health workers in sub-Saharan Africa by 2015.
Since the declaration of the eight Millennium Development Goals (MDG) in 2000, developing countries around the world have achieved uneven progress toward alleviating poverty, improving health, and promoting gender equality. While countries like China, India, and Brazil are on track to reach many of the MDGs, sub-Saharan Africa has fallen behind. The primarily rural communities of sub-Saharan Africa experience the highest childhood and maternal mortality rates in the world, lack access to health care services, and suffer from preventable and treatable diseases. With less than three years to the 2015 deadline, leaders in global development and global health are renewing their efforts to accelerate progress toward the MDGs in this region of the world.
In January 2013, the One Million Community Health Workers Campaign was launched by Rwandan President Paul Kagame, Professor Jeffrey Sachs, and Novartis CEO Joseph Jimenez at the World Economic Forum. This ambitious campaign aims to expand and accelerate community health worker (CHW) programs, scaling up to district, regional, and national levels through a top-down and bottom-up approach. The effort will begin with the training of national core groups, who will be responsible for training down to the local level and the simultaneous expansion of existing CHW programs to the national level using standardized protocols.
The technical report estimates that $3,584 is needed to train, equip, and maintain each CHW per year. The total cost of training and maintaining CHW initiatives is estimated to be $2.5 billion, assuming that each CHW serves between 500 to 650 people. This figure is reported to be within the budgetary means of the countries in the region.
This campaign marks an important milestone in the intensification of institutional support for CHW initiatives. For countries in sub-Saharan Africa, it’s no longer a matter of being able to afford and implement a national CHW program. CHWs are now seen as so imperative that these countries can no longer afford not to have a national program. African leaders were quick to endorse the campaign during a meeting of the African Union three days after announcement of the campaign on January 24th. In addition to this political support, the campaign has brought in partners from NGOs, aid organizations, UN agencies, and medical and technology companies.
From the perspective of scaling up peer support approaches through a similar mechanism, a scale up operation of this magnitude and complexity is exciting and inspiring and overwhelming. Even Sachs admits that the campaign is “a stretch” but he’s relying on the public health community to “move very fast and in partnership.” Interestingly, his comment seems to echo the observation by Maurits van Pelt, Director of MoPoTsyo Patient Information Centre in Cambodia, on why many peer support organizations fail to scale up in his blog. This campaign, then, will test the determination and ability of an international coalition to achieve system-level changes in a short span of time.
At the nascent stages of the campaign, we have a clear sense of what’s at stake, what the solution is, and a vision for how to achieve this goal. However, scaling up requires broad stakeholder buy-in, extensive and detailed planning, massive concurrent implementation, and the strengthening of associated infrastructures to support the scale up. Looking at the big picture, it seems that the process could be held up at any point from any direction.
The literature identifies the following barriers for scaling up public health innovations: inability to maintain reliable supply chains, demand size barriers to utilization, weak monitoring and evaluation systems, lack of policy support, lack of attention to sustainability, and inattention to the spatial elements of scaling up. (UNICEF Report, IHI Paper) We will be closely following this campaign to see whether it will be able to overcome these barriers and provide a model for scaling up CHW programs and other programs rooted in peer support across the world.
- CHWs will help sub-Saharan African countries achieve MDGs for child and maternal health, and disease treatment and prevention
- CHWs have demonstrated impact on MDGs 4, 5, and 6
- 4 – Reducing child mortality rates
- 5 – Improving maternal health
- 6 – Combating HIV/AIDS, malaria, and other diseases
- Political will, new financial resources, advances in mobile technology, and new point of care diagnostics provide momentum to support national CHW scale-up now
- Developing a CHW workforce meets strategic objectives
- Effective where primary health care system is weak
- Solution to shortage of highly skilled health workers in the face of growing demands
- Lasting return on investment: CHWs will be vital in post-MDG period for non-communicable diseases
- CHW activities will include:
- Providing basic treatment and preventive care
- Keep track of disease outbreaks and overall public health
- Link underserved residents with primary health care system
- CHWs work best when tightly linked to an appropriately financed primary health care system