In Guinea, Funding at the Local Level Paves the Way for Better Community Health
In Africa, community health systems are a crucial pillar of public health, delivering essential health services to reach communities even in the most remote areas. However, a major funding gap – US$4.4 billion annually – limits their reach, quality and long-term stability. Closing this gap and securing sustainable financing for community health systems are critical to ensuring health security across the continent.
At the heart of these local health systems are the community health workers who work on the frontlines of the fight against HIV, tuberculosis and malaria. They identify diseases early, support treatment adherence and reach populations often missed by the formal health system. But these essential health workers are often unpaid and unsupported, with financing for their lifesaving work fragmented and, in many cases, short-term.
In Guinea, this is beginning to change. Strong government commitment has been galvanized by catalytic support from the Global Fund-supported Project Building Integrated Resilience for Community Health (BIRCH). Implemented in partnership with Africa Frontline First, Project BIRCH supports 22 African countries to increase community health funding and strengthen health systems.
Unlocking US$18 Million for Community Health
In Guinea, Project BIRCH is being implemented by Integrate Health, which is providing technical support to the Ministry of Health and Public Hygiene as well as the Ministry of Territorial Administration and Decentralization. This partnership has effectively identified health financing needs and strengthened the development of budget and funding proposals for Global Fund support.
The results have already been remarkable. Guinea’s community health vision aligns closely with Global Fund priorities. As a result, US$18 million of the Global Fund’s 2023-2025 investments in Guinea support community health. This is a milestone for a country where community health workers were previously underfunded and largely overlooked in major global health financing streams.
A National Commitment to Sustainability and Strong Local Systems
While securing national funding is critical, sustainable progress depends on strong health systems at all levels – especially at the local level, where frontline services are delivered. To support this aim, a forum was held in Conakry, Guinea, in April 2024 to address key challenges in community health services delivery. The event brought together government representatives, civil society, technical and financial partners and community health workers, and resulted in a firm government commitment to integrate community health worker financing into municipal budgets.
That commitment quickly turned into action. In October 2024, a pilot initiative was launched to embed community health into local investment and planning across 10 rural communes in the Kindia and Mamou regions. Local officials received capacity-building support to integrate community health into their budgets. The momentum is growing – two communes (Soyah and Saramoussaya) have already allocated funding for community health worker salaries. Two additional communes (Damakania and Porédaka) are in the process of doing so, and the remaining communes are expected to follow.
Local ownership is making community health more visible in decision-making spaces and giving municipalities the tools to mobilize their own resources – such as local taxes or levies on businesses. By decentralizing community health financing, Guinea is building the foundation for a more resilient, country-led system – one that can gradually evolve beyond external support and move toward long-term sustainability.
At a time when international aid is shrinking and hard-won health gains are at risk, Guinea’s progress in community health is especially significant. These efforts reflect a growing recognition of the crucial role community health workers play, and the need to build systems that sustainably support their work.
Guinea is an important example of how smart financing, strong national leadership and effective technical partnership can come together to drive real, lasting improvements in community health.