Community Health Workers: the Future of Primary Healthcare

Authored by: Reese Visaya

Art by: Jane Wang

When clinics are hours away and doctors are scarce, how do rural communities get essential medications, vaccinations, and treatments? Many rural communities in Sub-Saharan Africa face barriers to receiving quality primary healthcare services due to distance to health facilities, rising care costs, and physician shortages [1]. Primary care is essential for maintaining good health, preventing illness, and the diagnosis and treatment of diseases. Without access to primary care, minor health concerns can be exacerbated to more severe and even life-threatening problems. Infectious diseases such as malaria, tuberculosis, and HIV, as well as non-communicable diseases like diabetes, hypertension, and anemia, require timely intervention and ongoing management and are highly prevalent in regions with limited access to care [2]. Additionally, lack of consistent pre and postnatal care contributes to the elevated maternal and infant mortality rates in the region [3]. 

Community Health Workers (CHW) are trained trusted members of a community, primarily women, who bring basic health services and education to communities [1]. They provide a variety of primary health services, including medication distribution, health education, maternal and prenatal support, immunizations, infectious disease prevention, chronic disease monitoring, and more [4,5]. By delivering care directly within communities, CHWs expand access to primary healthcare where traditional systems fall short and serve as a bridge between health services and the community [6]. 

CHWs have profoundly influenced community health in rural areas of Africa where they are deployed. Evidence from systematic reviews of the impact of community health workers in Africa suggests that CHWs have reduced waiting times, decreased healthcare costs, and increased disease management without compromising patient outcomes or quality. A 14 year longitudinal study in the Gambia found a 33% reduction in child mortality during the initial period of greatest investment in CHWs [7]. Care retention rates in Zambia, Uganda, and Rwanda have improved due to adherence counseling from CHWs [4]. CHW based approaches to maternal care were effective in reducing maternal mortality in Nigeria, Zambia, Tanzania and the Democratic Republic of Congo by up to 64% [3]. During the COVID 19 pandemic, community health workers played a critical role in surveillance and contact tracing [8]. These findings underscore the importance of CHWs as a cost-effective solution for strengthening primary care access in Sub-Saharan Africa. 

Community Health Workers are a unique and critical element of the health system in rural Africa and it is vital that these frontline workers are receiving adequate compensation and appropriate training. The current shortage of community health workers in Africa is estimated to be between 580,000 and 954,500 [8,9]. Additionally, CHWs are rarely equipped to deliver to their highest potential due to limited resources and funding [1]. In order to build more resilient and equitable health infrastructures in underserved regions of the world, it is imperative to recognize the invaluable contribution of CHWs and invest in strengthening their impact. 

Community Health Workers are a growing global strategy to close primary care gaps where formal health systems fall short. Achieving universal health care will require novel and tailored solutions in order to reach rural and underserved communities. The future of primary care in underserved regions may not begin in hospitals, but in homes, villages, and trusted community relationships.

References

1. These are the community health workers who are the heartbeat of global primary health care. UNICEF. https://www.unicef.org/stories/community-health-workers-heartbeat-global-primary-health-care 

2. Jeet G, Thakur JS, Prinja S, Singh M (2017) Community health workers for non-communicable diseases prevention and control in developing countries: Evidence and implications. PLoS ONE 12(7): e0180640. https://doi.org/10.1371/journal.pone.0180640

3. Orjingene, O. and Morgan, J. (2020) Effectiveness of Community Based Interventions in Reducing Maternal Mortality in Sub-Saharan Africa: A Systematic Review. International Journal of TROPICAL DISEASE & Health, 41 (9). pp. 9-21. ISSN 2278-1005

4. Mwai, G.W., Mburu, G., Torpey, K., Frost, P., Ford, N. and Seeley, J. (2013), Role and outcomes of community health workers in HIV care in sub-Saharan Africa: a systematic review. Journal of the International AIDS Society, 16: 18586. https://doi.org/10.7448/IAS.16.1.18586

5. Idriss-Wheeler D, Ormel I, Assefa M, Rab F, Angelakis C, Yaya S, Sohani S. Engaging Community Health Workers (CHWs) in Africa: Lessons from the Canadian Red Cross supported programs. PLOS Glob Public Health. 2024 Jan 18;4(1):e0002799. doi: 10.1371/journal.pgph.0002799. PMID: 38236795; PMCID: PMC10796059.

6. Ngongo N, Dereje N, Teriaky ME, Fallah MP, Shaweno T, Abdulaziz M, et al. (2024) Reinforcing community health workers program in africa for universal health coverage and global health security: A call for concerted efforts. PLOS Glob Public Health 4(9): e0003727. https://doi.org/10.1371/journal.pgph.0003727

7. Christopher, J.B., Le May, A., Lewin, S. et al. Thirty years after Alma-Ata: a systematic review of the impact of community health workers delivering curative interventions against malaria, pneumonia and diarrhoea on child mortality and morbidity in sub-Saharan Africa. Hum Resour Health 9, 27 (2011). https://doi.org/10.1186/1478-4491-9-27

8. Ngongo N, Dereje N, Teriaky ME, Fallah MP, Shaweno T, Abdulaziz M, Raji T, Guwani JM, Folayan MO, Ndembi N, Kaseya J. Reinforcing community health workers program in africa for universal health coverage and global health security: A call for concerted efforts. PLOS Glob Public Health. 2024 Sep 17;4(9):e0003727. doi: 10.1371/journal.pgph.0003727. PMID: 39288127; PMCID: PMC11407658.

9. Asamani JA, Okoroafor SC, Mwinga K. Community Health Worker Requirements to Accelerate Progress Towards Universal Health Coverage in Africa: An Overview of Contemporary Estimates and Implications of Full-Time Versus Part-Time Working Arrangements. Inquiry. 2025 Jan-Dec;62:469580251323381. doi: 10.1177/00469580251323381. PMID: 39991889; PMCID: PMC11851756.