The Critical Role of Community Health Workers in Pandemic Response
Community health workers (CHWs) have long played a vital role in preventing, detecting, and responding to pandemics around the world. These frontline workers, trained to deliver care within their own communities, have demonstrated their immense value time and time again, from the HIV/AIDS crisis to the Ebola outbreak and now the COVID-19 pandemic.
As seasoned experts in water, sanitation, and community engagement, we know firsthand the power of empowered, supported CHWs to save lives and build resilient health systems. During the COVID-19 pandemic, CHWs have stepped up to lead community-based infection prevention and control, facilitate safe sample collection, conduct contact tracing, accelerate vaccination rollout, and provide home-based care to those in quarantine. These versatile workers have been essential in maintaining equitable access to essential health services, even in the face of significant disruptions.
Yet, the majority of CHWs globally remain unpaid, under-resourced, and undervalued. This must change if we are to achieve true pandemic preparedness and response. To unlock the full potential of CHWs, we must fundamentally rethink the approaches of bilateral/multilateral aid and private philanthropy in supporting community health systems.
Unlocking the Power of Community Health Workers
CHWs have demonstrated their ability to play a critical role in pandemic response across diverse contexts. Some key examples of their contributions include:
- Leading community-based infection prevention and control: CHWs in Kenya, Malawi, and Uganda have educated communities on COVID-19 prevention measures, distributed personal protective equipment (PPE), and monitored compliance with safety protocols.
- Facilitating safe sample collection: In the Democratic Republic of the Congo, CHWs supported the Ebola response by collecting samples from suspected cases and transporting them to testing facilities, ensuring timely diagnosis.
- Conducting contact tracing: CHWs in Liberia were essential in tracking down contacts of Ebola patients, helping to curb the spread of the disease.
- Accelerating vaccination rollout: In India, CHWs known as ASHA workers have been instrumental in generating demand for COVID-19 vaccines and ensuring equitable access, particularly in hard-to-reach communities.
- Providing home-based care: During the COVID-19 pandemic, CHWs in Kenya, Malawi, and Uganda have delivered clinical care, distributed essential supplies, and provided psychosocial support to patients quarantining at home.
These examples illustrate the versatility and value of CHWs in responding to public health emergencies. However, to fully leverage this cadre of frontline workers, we must address the systemic underinvestment and lack of professionalization that plagues community health systems globally.
Rethinking Aid and Philanthropic Practices to Support Community Health Systems
The COVID-19 pandemic has exposed the deep inequities and vulnerabilities in health systems around the world. It has also presented a critical opportunity to rethink the ways in which bilateral/multilateral aid and private philanthropy support community-level health services.
Far too often, these funding sources have perpetuated harmful practices that undermine the very systems they aim to strengthen. These include:
- High transaction costs: Extensive reporting requirements and complex grant management processes divert precious resources away from direct service delivery.
- Earmarking: Funds are often restricted to specific, donor-driven priorities, rather than aligning with government-set goals and community needs.
- Short-termism: Project-based, time-limited funding hinders the development of sustainable, long-term solutions.
- Appropriation of sovereignty: Donor-driven agendas can override the decision-making authority of national governments and local stakeholders.
These practices have directly contributed to the precarious state of community health systems, with the majority of CHWs remaining unpaid, under-resourced, and unsupported.
To create resilient health systems capable of withstanding future pandemics, we must replace these harmful practices with approaches that enable sovereign, government-led community health programs to thrive. This includes:
- Pooling resources: Aligning bilateral, multilateral, and philanthropic funds to support a unified, national community health strategy, as exemplified by the Community Health Roadmap Catalytic Fund in Malawi and Zambia.
- Longer-term commitments: Providing sustained, flexible funding that allows for the steady, long-term execution of government priorities, rather than short-term, project-based support.
- Alignment with evidence-based guidelines: Basing investments on the WHO’s Community Health Worker Guidelines and the Community Health Worker Assessment and Improvement Matrix, which outline the key elements of high-performing community health programs.
By embracing these practices, funders can help create the conditions for CHWs to be fully integrated into national health systems, equipped with the necessary training, supervision, remuneration, supplies, and decision-making power to fulfill their vital role.
Seizing the Moment for Landmark Policy Change
The COVID-19 pandemic has exposed the critical importance of strong, resilient primary health care systems, with CHWs serving as the backbone of community-level service delivery. This crisis moment presents a unique opportunity for landmark policy changes that can transform the status quo and propel community health systems into a new era of achievement.
One such example is Liberia’s launch of a national cadre of paid, professionalized CHWs following the Ebola outbreak. Similarly, in Uganda, the government announced plans to compensate CHWs, known locally as village health teams, for their role in combating COVID-19, describing it as a “dream” they had held for the past 20 years.
These policy shifts demonstrate that crises can catalyze the necessary political will and public momentum to address long-standing systemic issues. By working in partnership with national governments to strengthen community health provision, bilateral/multilateral aid and private philanthropy can help ensure that we are all better prepared to face future pandemics.
Conclusion: Investing in Community Health for Pandemic Preparedness and Response
Community health workers have long been the unsung heroes of pandemic response, yet their critical role has often been overlooked and under-supported. The COVID-19 crisis has brought this disparity into sharp focus, underscoring the urgent need to professionalize and empower CHWs as part of resilient, equitable primary health care systems.
To achieve this vision, bilateral/multilateral aid and private philanthropy must fundamentally rethink their investment practices. By aligning with government-set priorities, providing sustained, flexible funding, and adhering to evidence-based guidelines, these global health actors can help catalyze the policy changes necessary to unlock the full potential of community health workers.
The time is now to seize this crisis as an opportunity for landmark improvements in our ability to reach and serve everyone, even in the most challenging circumstances. By investing in community health, we can build the foundations of pandemic preparedness and response that will protect the most vulnerable populations for generations to come.
