Strengthening Health Systems in sub-Saharan Africa by Building a Pipeline of Trained, Qualified, Paid, and Motivated Female Community Health Workers (CHWs) 

By Mercy Okaalet, LGT Impact Fellow for mothers2mothers

Community Health Workers (CHWs) play an essential role in providing health care services to communities on the African continent and beyond. In the six pillars of a robust health system, one of the recommendations from the World Health Organization (WHO) is a “trained and motivated health workforce”, which includes CHWs. These dedicated individuals are essential in reducing Africa’s disease burden and ensuring access to primary health care by bridging the gap between the health system and the communities they serve. CHWs contribute to universal health coverage (UHC) by improving access to health services, representing a much-needed additional resource in critically under-resourced and under-staffed health facilities, reducing the financial burden, promoting healthy lives and well-being for all, and in turn contributing towards improved health outcomes. 

Despite the crucial role that CHWs play in the delivery of health care, the reality is that most CHWs in Africa do not have formal employment or a steady income. Only 14% of CHWs in Africa are salaried, meaning that most of these workers go unpaid. Adding to this fact that women account for 70% of the health sector workforce, this lack of compensation reveals that women’s economic empowerment is stifled and that their society continues to take advantage of these skilled women as free labour.

African organisations like mothers2mothers (m2m) who are investing in female grassroot leadership are helping turn the tide and create a wave of health and well-being for the communities they work with across sub-Saharan Africa. By training and employing local women living with HIV as CHWs—known as Mentor Mothers— who work in both health facilities and go door-to-door in communities, m2m ensures that women, children, adolescents, and their families can get the health care services and support they need, wherever and whenever they need it. By providing this formal employment, training, skills, and fair compensation, m2m is supporting female CHWs in 10 African nations to deliver vital health care services to their communities in a sustainable way.

And the impact speaks for itself. Since its creation in 2001, m2m has employed almost 12,000 Mentor Mothers across a dozen of African nations, who in turn have reached over 15 million women, children, adolescents, and families with life-saving health services, education, and support. In addition, they achieved virtual elimination of the transmission of HIV from mother-to-child among their enrolled clients for eight years in a row, and helped to keep more than 2 million women and children alive, who may otherwise have been at risk of maternal or child mortality. This progress has been made possible thanks to the tireless work and dedication of Mentor Mothers, who continue to be the backbone of everything that m2m does.

In addition to paying CHWs, m2m actively advocates for the recognition, certification, and accreditation of CHWs at the national level. CHWs are an integral part of national health infrastructures, and a cadre of certified and accredited CHWs leads not only to better health outcomes for the communities they serve, but also career advancement pathways for the CHWs themselves.

CHWs are passionate about caring for and improving the well-being of their communities—but like with any job, fair and adequate compensation results in a hardworking, motivated, and dependable workforce. That is why it is important for countries to not only curb the current health worker shortage by hiring an adequate number of CHWs (WHO predicts a shortage of 6 million health workers by 2030 in Africa), but to also shift from offering performance-based, irregular, or non-financial incentives to providing fair compensation and recognition for all CHWs.

Fair pay, training, formal recognition—those are all things that motivate us to work harder. It helps build the confidence of our community in us as professionals. It means our work is valued. It means we can help to reach the Global Goal of Health for All. It also changes our own lives.

Bupe Sinkala, m2m community health worker and Spokeswoman from Zambia

m2m is proud to have established and sustained a successful model that not only improves the livelihoods of CHWs, but also positively impacts the communities they serve. As a policy officer fellow working with an experienced team, our goal is to continue to educate and influence decision-makers to adopt and replicate this model of investing in and supporting CHWs to bring about widespread change in health care delivery and ultimately work to achieving UHC.