At least half of the world's population does not have access to the essential health services it needs. A combination of economic, social, and geographic barriers - compounded by a global shortage of health care workers - prevent people from accessing primary health care (PHC).1 The shortage of health care workers, estimated at 7.2 million health workers today, is expected to widen to 18 million by 2030, according to the World Health Organization.

Community health workers (CHWs), as part of primary health care teams, can help fill this critical gap. CHWs can be trained much more quickly than doctors, nurses and other frontline health workers, allowing governments to ramp up services relatively quickly, to meet critical needs. Despite their narrower skill set, CHWs can provide PHC services that address some of the most important causes of maternal, child and neonatal mortality, improve sexual and reproductive health, and prevent and treat other communicable and non-communicable diseases. Critically, CHWs deliver care on the doorsteps and in the communities of those who need it most. By providing these services in otherwise overlooked or underserved communities, CHWs expand access to PHC services, improve health, and save lives, particularly in rural, remote, and vulnerable communities, and where there are cultural barriers to health care.

Even in geographies with a robust health workforce, CHWs can improve health outcomes by serving as effective health educators, increasing demand for health care and promoting healthy behaviors, such as exclusive breastfeeding, support for immunization, proper complementary feeding, and proper sanitation.

The power of CHWs

Investing in CHWs is a powerful way to increase access to PHC services, increase health-seeking behavior, and improve clinical outcomes because CHWs of the following:

Geographic proximity

CHWs reduce the travel time and cost needed to access medical care, making it more accessible and timely. Rural-focused programs have higher costs than programs that include urban CHWs. In general, cost per person served decreases as the scale of the program increases. Rural programs, however, are typically more effective because they reach populations with poor access to health care.

Trust from the community

As trusted members of the community they serve, CHWs can improve demand for services and accelerate behavior change. CHWs can sensitively address traditional customs and norms that undermine health. Their fluency with culturally appropriate language, and mechanisms for communicating health and hygiene best practices can ensure better competence with health instructions.

Frequency of contacts

Too often, remote communities' only contract with health systems is via intermittent campaigns. CHWs shift this paradigm by providing regular services that meaningfully extend the continuum of care. By virtue of living and working the community, they can monitor chronic health conditions or continually reinforce key health messages - such as the importance of exclusive breastfeeding or proper complementary feeding for infants - and readily identify unmet health needs.

Bridging community and health and welfare services

CHWs can serve as a bridge between the formal health system and vulnerable communities, helping their colleagues, such as nurses and doctors, better understand the patients they serve and prioritize their time addressing more complex medical problems. CHWs also help patients, who may have no previous experience with preventive care, better appreciate the benefits of and follow the unfamiliar protocols of preventive care. Likewise, they can link communities to other government social services that may impact health. Furthermore, CHWs can help patients navigate complex health systems and ensure they comply with recommended treatment and follow-up visits.

  1. 1
    Tracking universal health coverage: 2017 global monitoring report. World Health Organization and International Bank for Reconstruction and Development / The World Bank; 2017. Licence: CC BY-NC-SA 3.0 IGO.

What impact can CHWs have?