Achieving progress on universal health coverage and the Sustainable Development Goal health targets requires a strong primary health care sector as the cornerstone of health systems. The World Health Organization Executive Board, convening in Geneva from 24 January to 1 February, has taken an important step in supporting and recognizing the importance of community health workers (CHWs), as part of a diverse and sustainable health workforce skills mix.
“Promotive, preventive, curative, rehabilitative services and palliative care must be accessible to all… We can no longer underemphasize the crucial importance of health promotion and disease prevention, nor tolerate fragmented, unsafe or poor-quality care. We must address the shortage and uneven distribution of health workers.”
Declaration of Astana
The Executive Board adopted a resolution introduced by the Governments of Ethiopia and Ecuador, entitled “Community health workers delivering primary health care: opportunities and challenges”. The document, which builds on both countries’ experience and the Declaration of Astana, underscores the value of community health workers as a vital health system component in providing primary health care services.
The resolution, which will be considered at the World Health Assembly in May 2019, takes note of the newly-launched WHO Guideline on health policy and system support to optimize community health worker programmes (CHW Guideline), which consolidates evidence on the effectiveness and cost-effectiveness of CHWs. The CHW Guideline recommendations relate to opportunities and challenges for the successful education, remuneration, deployment and supervision of community health workers, adapted to national context and health needs. Every day throughout the world, community health workers deliver a range of preventive, promotive and curative health services, in particular to underserved populations and in situations of emergency.
Community health workers often are the first link in the primary health system, like the proverbial Dutch boy who placed his finger in the dyke to hold back flooding. They contribute to epidemic preparedness and response; deliver vaccinations that have brought the world much closer to being polio-free, among other vaccine-preventable diseases; and provide life-saving integrated community case management diagnosis and treatment for pneumonia, diarrhoea and malaria, which can be deadly for children under the age of 5. These workers are key players in global health security, barriers against the spread of outbreaks; they sustain action against infectious diseases and are life savers. To be successful, they need to be linked better with health systems and provided with the necessary support, remuneration, supervision and tools.
With specific emphasis on access to services, safety and quality of care, as appropriate to national context, the draft resolution calls for more and better investment in community health worker and broader health workforce programmes. Globally, women hold 7 in 10 jobs in the health and social sectors. Accelerating investments in job creation and decent work in primary health care will positively impact women and youth, drive economic growth and support progress toward the Sustainable Development Goals. The draft resolution exhorts national governments, global health initiatives, bilateral and multilateral financing agencies and development banks to support national CHW programmes through programme development and financing decisions to support human capital and health workforce development.
The governments of Algeria, Botswana, Brazil, Canada, Georgia, Kenya, Liberia, Luxembourg, Netherlands, Panama, South Africa, Switzerland, the United States of America, Zambia and Zimbabwe are co-sponsors of the draft resolution. Civil society organizations the Frontline Health Workers Coalition, AMREF Health Africa, International Association for Hospice and Palliative Care Inc., International Pharmaceutical Federation, The World Medical Association, Inc., The Worldwide Hospice Palliative Care Alliance and World Organization of Family Doctors added statements to the Executive Board discussion. Recognizing this vigorous support and the evidence presented in the CHW Guideline, it is time to strengthen policy, programme implementation and resourcing of community health workers as part of an integrated health workforce that is strengthening primary health care and accelerating progress toward health, education, employment and equity-related Sustainable Development Goals.
As part of the Global Strategy of Human Resources for Health: Workforce 2030, the World Health Organization and its Health Workforce department look forward to collaboration with relevant partners to advance implementation of the guideline and the draft resolution