A new philanthropic project hopes to invest $100 million in 10 countries, mostly in Africa, by 2030 to support 200,000 community health workers, who act as a critical bridge to treatment for people with limited access to medical care.
The Skoll Foundation and The Johnson & Johnson Foundation announced Monday that they are donating a total of $25 million to the initiative. The Global Fund to Fight AIDS, Tuberculosis and Malaria, which will oversee the project, matched the donations and hopes to raise another $50 million.
The investment seeks to strengthen frontline workers who experts say are critical to combating outbreaks of COVID-19, Ebola and HIV.
“What have we found out about community health workers?” said Francisca Mutapi, a professor at the University of Edinburgh who is helping to lead a multi-year project to treat neglected tropical diseases in several African countries. “They’re very popular. They’re very effective. They’re very cost-effective.”
On a recent trip to Zimbabwe for research, Mutapi described how a community health worker negotiated the treatment of a parasitic infection in a young child who was part of a religious group that does not accept clinical medicine.
“She is going to the river, going about her daily business, and she notices that one of the children in her community is complaining of a stomach ache,” Mutapi said.
The woman approached the child’s grandmother for permission to bring the child to a clinic, which diagnosed and began treating the child for bilharzia. It would not have happened without the woman’s intervention, Mutapi said.
Ashley Fox, an associate professor specializing in global health policy at Albany, SUNY, said evidence shows that community health workers can effectively deliver low-cost care “when they’re properly equipped and trained and paid — that’s a big caveat.”
Although the current number of these workers is not well documented, the Africa Centers for Disease Control and Prevention estimated in 2017 that the continent required 2 million to meet its health targets. Many of these workers are women and unpaid, although The Global Fund is advocating for some kind of pay for them.
“It’s hard to think of a better set of people that you want to pay if you think about it both from the point of view of creating good jobs and maximizing the health impact,” said Peter Sands, the fund’s chief executive. .
The Global Fund, founded in 2002, channels international funding with the goal of eradicating treatable infectious diseases. In addition to its regular three-year grants to countries, it will distribute these new philanthropic donations through a catalytic fund to encourage use of some of the best practices and program designs.
Last Mile Health, part of the Africa Frontline First health initiative, has been working with the Liberian government to expand and strengthen its community health program since 2016.
In the early months of the COVID-19 pandemic, former Liberian president and Noble Peace Prize recipient Ellen Johnson Sirleaf convened Last Mile Health and other organizations to wrestle with a response.
“We all kind of had a deja vu moment remembering back to a couple of years ago when Liberia was hit by this tragic Ebola epidemic,” said Nan Chen, CEO of Last Mile Health. “And as President Sirleaf reminded us: The tide was turned when we approached the community.”
Together with the other organizations specializing in public health funding, research and policy, they set out to design an initiative to expand public health programs and to capitalize on the attention the pandemic brought to the need for disease surveillance.
The catalytic fund is the result. “I think the pandemic has shed light on the critical role of these healthcare workers,” said Lauren Moore, vice president of global community impact at Johnson & Johnson.
Don Gips, executive director of the Skoll Foundation, emphasized that these workers can also provide early warnings that benefit people everywhere.
“It’s important not only for delivering health care in Africa, but this is how we will also catch the next set of diseases that could threaten populations around the world,” said Gips, who is also a former US ambassador to South Africa.
Last Mile Health won a large donation from the Skoll Foundation in 2017 and has also received large donations from the Audacious Project of TED and Co-Impact, another funding collective. The organization’s co-founder, Raj Panjabi, now serves in the Biden administration.
“What philanthropy has noticed about Last Mile Health is that we not only directly addressed the problem by actively managing community health worker programs, but that we saw our innovation adopted into national policy at scale,” said James Nardella, the organisation’s program manager.
SUNY’s Fox and other experts say linking the work of community health workers to the national health system is a priority, along with ensuring sustainable funding for their programs.
The global fund said it will help countries design proposed expansions of community health workers over the next year.
Chen acknowledged that there is no silver bullet for the issue of sustainability.
“Part of the work that organizations like Last Mile Health have to do is sit in the discomfort and wrestle with it, with our partners, with donors, until we gradually push out the solution here,” Chen said.
Mutapi said governments must ultimately fund the programs themselves, and she argued that the experiences of places like Zimbabwe and Liberia with community health workers could also benefit people in other contexts.
“Actually having lived on Scottish islands, which are inaccessible,” she said, the innovation of community health workers “is something that can actually be exported to western communities that are remote because that connection between a health worker and the local community is very important for compliance and for access.”
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