Community Health Workers

Community health workers are at the heart of what we do – they are critical to fighting HIV, tuberculosis (TB) and malaria, and achieving universal health coverage. They expand access to basic primary health care services in remote areas and with marginalized populations, and perform critical work to prevent, detect and respond to disease outbreaks in the communities they serve. They carry out home visits, provide health information, test for and treat simple illnesses, refer people to primary health facilities when necessary, collect health data, monitor disease outbreaks and conduct disease surveillance, and distribute lifesaving health products such as mosquito nets and medicines.

There are over 3.8 million community health workers globally across at least 98 countries. However, this number of essential health workers is not enough to meet global needs. Additionally, many of them are not adequately trained, supervised or compensated to effectively attend to their communities.

In addition, around 70% of these workers are women, who are more at risk of experiencing gender-based violence. Many community health workers and peer educators also belong to marginalized populations that can be subjected to stigma, discrimination or criminalization.

Community health workers deserve to be treated as the professionals they are – paid, trained, supervised, equipped and protected. They form a trusted bridge between the health system and communities – and should be valued as such.

Their jobs should be integrated in the primary health care system of countries and sustainably financed. Supporting these workers is not only a matter of fairness but also essential for achieving health equity in the communities they serve.

The Global Fund is committed to community health and is making long-term investments to support that commitment. Over the 2024-2026 period, we are investing over US$900 million in community health workers, a 32% increase on the previous three-year period. Aligned with national plans, Global Fund investments support training, supervision, professional materials, health products, digital tools, means of transport and personal protective equipment. Our programs finance the policies that build a strong infrastructure for community health workers, including:

• Strengthening governance, planning, coordination and the alignment of donors with national plans.
• Strengthening capacity within ministries of health as well as community-led and community-based organizations.
• Policy and strategy reforms, and sustainable financing.

We also provide funding for advocacy efforts aimed at securing legal protection and recognition for community health workers, with the goal of ensuring they receive the appropriate pay and working conditions they deserve.

As well as working in remote areas, community health workers and peer educators are essential for reaching key and vulnerable populations. They support the health needs of LGBTQI+ people, refugees, migrant workers, sex workers, people who use drugs and people in prison.

They conduct targeted interventions – such as providing prevention services and products – in non-medical environments where some members of the community are more comfortable. Peer educators provide training and education, including for young women at risk of acquiring HIV due to harmful gender norms and inequality. Community health workers also play a vital role in improving maternal and child health, especially against the challenges of HIV, TB, malaria and other infectious diseases.

Community health workers are the foundations of resilient and sustainable systems for health and must be integrated in a country’s health service in order to fully play their role. Evidence from countries like Liberia and Ethiopia demonstrates that improved training, supervision, fair compensation, integration of community health workers into the health system and sustainable financing for community health workers lead to better health outcomes for all.

The Global Fund supports the Monrovia Call for Action, which advocates for the professionalization of community health workers, and the Lusaka Agenda, which calls for more investments to strengthen resilient health systems, including at the community level.

The Global Fund’s private sector partners are uniquely positioned to advocate for and help increase public, private and philanthropic funding for community health, thanks to their diverse experience, influence and networks.

Our investments include a US$100 million catalytic investment that grew out of our partnership with the Africa Frontline First Initiative, and we developed the AFF-Catalytic Fund (AFF-CF) together with private sector funding. This catalytic funding aims to strengthen and finance community health in eight countries in Africa – Burkina Faso, Côte d’Ivoire, Ethiopia, Kenya, Liberia, Mali, Senegal and Zambia. It received strategic investments of US$15 million from the Johnson & Johnson Foundation and US$10 million from the Skoll Foundation.

In addition, the Global Fund has invested nearly US$26.5 million in technical assistance via the Building Integrated Readiness for Community Health (BIRCH) Project, delivered by our partner Last Mile Health. In 2023, BIRCH provided technical assistance to ministries of health and community-led organizations to strengthen community health programs in 10 African countries: Burkina Faso, Côte d'Ivoire, Ethiopia, Guinea, Liberia, Malawi, Mali, Mozambique, Sierra Leone and Zambia. For 2024-2025, BIRCH is expanding technical assistance support to 13 more African countries – Cameroon, Central African Republic, Chad, Congo, Ghana, Guinea-Bissau, Madagascar, Niger, Nigeria, South Sudan, Tanzania, Uganda and Zimbabwe – bringing the total to 23. This was made possible thanks to our COVID-19 funding, part of which has been aimed at boosting support for community health workers.

Digital health is a key part of supporting community health in low-and-middle income countries. Using mobile phones, community health workers can follow their patients’ health progress, collect community data for disease surveillance and link household data with central health information systems. Digital tools in the hands of community health workers and their supervisors improve the quality of community health services.

Many of our digital health investments are financed through our three-year grants as well as through the Data Science Catalytic Fund, a US$25 million collaboration between the Rockefeller Foundation and the Global Fund. Together with Co-Impact and Last Mile Health, we are also providing implementation support and technical assistance, including digital health tools, to strengthen Liberia’s National Community Health Assistant (CHA) program.