Developing a large cadre of highly trained community health workers (CHWs) in sub-Saharan Africa is key to stemming future outbreaks of deadly diseases such as Ebola as well as achieving universal healthcare, according to a new report by international healthcare experts and African leaders.
It will take at least $3 billion to add the 700,000 community healthcare workers needed to adequately address Africa's healthcare needs, according to the report, "Strengthening Primary Health Care through Community Health Workers: Investment Case and Financing Recommendations." But the authors contend that every dollar spent on CHWs delivers 10 times the financial return while, at scale, preventing up to 3 million deaths per year.
The health workers will need to be highly trained and skilled, and integrated into teams of nurses and other health workers from clinics in each nation's primary health system, two of the report authors noted in a blog post published by the Huffington Post.
Each nation will need to develop ways to measure and manage the performance of its community health program and how it's integrated into the rest of the primary health system, Jeff Walker, vice chair of the U.N. Secretary General's Envoy for Health Finance and for Malaria, and Rajesh Panjabi, CEO of Last Mile Health, wrote in the article. National efforts also will need to include leadership from the health ministries and engage communities in how to design health programs.
Successful financing programs should combine international donations and other funding sources with domestic resources, the report contends. It outlines a four-step process for developing financing: determining the required program scale, costing the plan year-by-year, setting financing targets for each year by funding source, and identifying specific financing mechanisms to meet targets.
"This panel believes high-performing CHW programs can be financially self-sustaining in the long term by sharing the financing burden among the program beneficiaries (which include private employers and private healthcare providers) and by capturing gains that result from economic growth," according to the report's executive summary.
The report's findings echo in many ways similar recommendations for U.S.-based CHW programs in a recent opinion article published in the New England Journal of Medicine. Among the recommendations in that article were integrating CHWs into formal healthcare teams and avoiding fragmented, disease-specific interventions. Research indicates CHWs can be particularly effective in helping patients with chronic conditions such as diabetes, as well as those with multiple chronic illnesses, patients in high-poverty areas and patients without insurance.