COMMUNITY HEALTH Worker Master List
Strong, sustainable health systems AT the Community Level that provide access to quality healthcare for all
VISION
MISSION
The Community Health Roadmap’s mission is to mobilize new resources to support national priorities for community health, and to support the more efficient use of existing resources through stronger collaboration, coordination and alignment of donor investments.
“The global visibility of our priorities is critical for us. We need partners both at the country-level and globally to understand them. We value the opportunity to actively present this Roadmap.”
– Ministry of Health, Malawi
The Community Health (CH) Roadmap is an innovative collaboration between traditional multilateral and bilateral donors, private funders and global health leaders including USAID, the World Bank, the WHO, the Bill & Melinda Gates Foundation, The Rockefeller Foundation, UNICEF, and Office of the WHO Ambassador for Global Strategy to better align existing resources and to attract new resources to community health and support countries in achieving their goals for PHC, UHC and SDG3.
The Roadmap works with Ministries of Health across multiple countries to identify community health national investment priorities that strengthen primary health care. We advocate with partners and donors for greater investment around these needs and priorities, and disseminate up-to-date information, insight and opportunities for high-impact investments in Roadmap countries.
The Knowledge Hub is our living repository for country information, updated as national priorities change, progress made, and milestones achieved.
What is the Community Health Roadmap?
The Catalytic Fund
The Catalytic Fund was established as a response to the need to fill this gap in the funding landscape. The objective of the Catalytic Fund is to provide modest amounts of funding to the Ministries of Health to advance and catalyze their community health national priorities.
Ministry of Health teams can apply to the Catalytic Fund for activity-based grants, or for technical assistance. The Catalytic Fund can accommodate a variety of needs including: financial gap analyses, investment cases, advocacy campaigns, country peer-to-peer learning, and testing of a system improvement, as examples. The aim for all of these projects is to unlock more funding for the Ministry of Health, address a significant bottleneck, or test a system improvement or innovation that can be scaled.
The Catalytic Fund became operational in March 2020, with an invitation to a few countries to apply and test the design. In response to country requests, the Catalytic Fund expanded its scope to include catalytic support of COVID-19 responses at community level.
So far the governments of Afghanistan, Malawi and Zambia have received funding for their COVID-19 response through community health; and the governments of Liberia and the Democratic Republic of Congo have received support for their community health strategy development.
CONTEXT
WHAT IS COMMUNITY HEALTH?
Community health is a critical part of the primary care continuum to address people’s health needs. Community health can be defined in many ways, but for the purposes of this roadmap, it includes:
Health promotion and service delivery activities that occur primarily outside of a health facility
Both supply of and demand for health care, including activities that community members undertake as agents of their own health
Community health workers (CHWs) as one, but not the only, delivery channel
Delivery through public, NGO, and private sectors
Linkages to a broader multi-sectoral community system
Throughout this roadmap process, national governments and their key partners will define the most critical actors in community-level primary health care systems and their roles in achieving outcomes.
WHY COMMUNITY HEALTH?
Extending preventive, promotive, and curative health services into communities is a critical aspect of ensuring access to high-quality primary care. Community health efforts can also provide a cost-effective platform to countries pursuing universal health coverage, especially given the potential to address multiple health needs with integrated community-level approaches.
Despite growing momentum and country-level progress, community health programs are massively underfunded. For example, scaling community health worker programs in Sub-Saharan Africa would require an additional $2B annually. Where funding does exist, it is often fragmented and uncoordinated, with little alignment to national strategies. This can lead to fractured approaches, insufficient community ownership, and poor integration with the rest of the primary health care system.
This is an especially important moment to act on community health, building on the country commitment and global partner alignment around primary health care surrounding the 40th anniversary of the Alma-Ata Declaration.
Source: Financing Alliance for Health and USAID ”Closing the $2 Billion Gap”, 2017.
Impact
Impact Analysis
Estimating the impact potential of fully optimized community health platforms in fifteen countries of the Roadmap
The Roadmap aims to elevate national priorities and create a common agenda for investments in community health to strengthen primary health care, which could yield a triple impact:
Bridging the gap in survival, by accelerating mortality reductions to achieve SDG 3.1 and SDG 3.2
Bridging the gap of equitable access, by extending the healthcare system to where people face the biggest barriers to access
Bridging the gap in thriving, by ensuring equal opportunities for all to thrive
So far, fifteen countries have been selected for initial inclusion in the Roadmap. Linked with the Roadmap’s activities to collaborate with the Ministry of Health and key partners in these countries to define national community health priorities, we began an effort to describe and quantify, where possible, the triple impact of all fifteen Roadmap countries having fully optimized community health platforms as part of primary health care (Figure 1).
In particular, we used the Lives Saved Tool (LiST) to project the potential impact on bridging the gap in survival. The total number of lives saved is estimated to be ~550,000 between 2020 and 2030 across the fifteen countries from fully optimized community health platforms1. Figure 2 shows the estimates by country.
These results could serve two purposes:
As the numeric anchoring point for describing the full impact potential on lives saved across all fifteen initial Roadmap countries
As “draft zero” for revision in consultation with the Ministry of Health of each Roadmap country to develop more precise estimates based on country-specific assumptions (such as coverage targets and community health intervention package). The Roadmap is making catalytic funding available to support countries interested in conducting this analysis, aiming for an initial wave of countries to complete the analysis by ICHC2020.
Figure 1. Triple impact of fully optimized CH platforms in fifteen Roadmap countries
Figure 2. Estimated impact on lives saved
1 For this exercise, we defined "fully optimized community health platforms" as being able to effectively implement a comprehensive package of interventions at the community level and achieving at least 90% population-level coverage of each intervention by 2030. This comprehensive package of interventions was defined based on a review of literature and national policy and strategy documents from the fifteen Roadmap countries that specified a list of interventions to be implemented at the community level. A full summary the methodology used for the LiST-based analysis can be found in the Appendix.
2 Lives saved from reducing unmet need for family planning is not included in this analysis. This decision is mainly due to the challenge of defining a specific share of unmet need addressed (e.g., 90%) associated with community-level service delivery vis-à-vis other parts of the healthcare system. While the effective provision of several contraception methods at the community level is well demonstrated, the rest of the health care system (especially primary care level) is also essential to ensuring the opportunity for women to obtain a method that suits their needs.
3 The "gap closure effect" for a given mortality indicator is the estimated mortality rate reduction in 2030 attributed to fully optimized CH platforms relative to the total projected gap in 2030 between following the current trajectory and the SDG target.
4 In addition, the projected "gap closure effect" for neonatal mortality is 23%
5 Population across the fifteen Roadmap countries
You can find more about the methodology here.
Country’s Investment Priorities
In consultation with UNICEF and USAID country teams – countries led this process by engaging with community-health partners and stakeholders to arrive at the most pressing priorities to be implemented over the next three-to-five years.
A rigorous methodology measuring feasibility, scale of impact and strength of governance applied to 58 countries yielded the 15 Roadmap countries*.
Examples of the national priorities among the Roadmap countries include the following:
Close the human-resources gap;
Identify sustainable financing sources for community health;
Develop comprehensive community-health strategy;
Improve technology infrastructure to enhance communication;
Increase supplies and commodities at community level;
Harmonize data reporting for community health; and
Construct health posts
Click on a country in the list to learn more about the national community health priorities identified so far.
* India opted-out of the Roadmap process and in its place, Kenya was added.
Cross-Cutting Investment Priorities
In addition to national priorities, in-country and global stakeholders identified a set of priorities that can strengthen community health systems across countries. Cross-country investments are open resources such as toolkits, checklists, guides, convenings, new technical assistance programs, new analyses and research.
Building on the national priorities and other expert consultations, the Roadmap has identified six cross-country investment priorities:
Financing:
Mobilize funding for CH/PHC, including sustainable domestic financing
Fragmentation:
Reduce fragmentation by integrating community health into national system in particular in areas of human resources, supply chain, and information systems
Optimization:
Optimize the quality of design and implementation of CH programs
Future fit:
Identify design options for future CH/PHC systems
Performance management:
Enhance performance management systems for CH
High-level commitment:
Foster high-level political commitment to community health, in line with existing movements to achieve SDG 3
For each of the investment priorities, the Roadmap defined a desired end-state any investments should lead to as well as a list of example investments that can be considered to achieve this investment objective.
Investments in each priority area have to build on existing investments and on-going work. Examples can be found here.
Please click here for the methodology for each of the six investment priorities as well as detailed descriptions of each of the six investment priorities, as well as more detailed landscaping of on-going work to be built upon.
RESOURCES
Framing Community Health and Primary Health Care
Trainings and presentations
COMMUNITY HEALTH ROADMAP
Investment priorities to scale primary care at the community level