Community Health Impact Coalition (CHIC) has created a movement out of one big idea—collective action through radical collaboration—to achieve systems change . The goal? To make professional community health workers (proCHWs) the norm worldwide , in order to achieve the vision of health for all including those who provide it.
To that end, CHIC is working to change guidelines, funding and policy through a three pronged approach: researching to equip international norm setters with evidence; advocating to influence global financing institutions; and by activating in-country networks to win national policy change. The approach is having widespread impact—from influencing proCHW best practices in WHO’s inaugural CHW guidelines to successfully influencing policy change, CHIC has achieved an impressive list of wins since its founding in 2019.
Aligning with CHIC’s principle that those best placed to advocate for solutions are CHWs themselves, the Johnson & Johnson Center for Health Worker Innovation, with funding from Johnson & Johnson Foundation, has been supporting CHIC’s CHW Advocates program since 2020. The program aims to equip 10,000 CHW advocates to be effective champions for their own workforce needs and to demand the implementation and scale-up of quality-improving practices for community health. The project includes funding a free digital app designed to empower CHWs with the skills to effectively share their stories as experts and promote the health issues most important to their communities and ultimately help CHIC achieve its long term goal to seed an International Association of CHWs.
We spoke with Kenya-based Carolyne Wanyonyi, CHW Engagement Lead at CHIC, for her insights on why making proCHWs the norm worldwide is so critical today to improve health outcomes and achieve health equity.
Tell us more about CHIC’s #proCHW movement and the big idea—collective action through radical collaboration.
Community health workers have been a global cornerstone of primary healthcare for more than a century and there is plenty of evidence that their work improves health outcomes. Yet, professional CHWs are still the exception and not the norm. The # proCHW movement is designed to confront the widespread issue of CHWs not being salaried, skilled, supervised and supplied. This means that CHWs are exploited and less effective for patients.
CHIC is an audacious, 60-country movement, comprised of thousands of CHWs and dozens of global health organizations, all of which endorse proCHW best practices, and are driving our joint work. We exist because community health workers work. Our idea is that radical collaboration spreads good design, driving results faster. This allows us to wield influence on a scale sufficient to change global norms.
Our shared mission is to make proCHWs the norm worldwide by changing international guidelines, increasing global funding and winning national policy. We strive for quality care for all, including those who supply it. Good health only happens if there are good working conditions.
How does better equipping and compensating CHWs improve community health and health equity?
Research has shown that governments can generate a 10:1 return on investment with CHWs and proCHWs could save two million lives annually.
Across my career I’ve seen indisputable evidence that professional CHWs promote health equity in a variety of ways. One is increased effectiveness: when CHWs are well trained and equipped they can provide more effective healthcare services and boost the uptake of the services they offer, leading to improved health outcomes in their communities. Another is improved access: when CHWs are properly integrated into the health system, they can improve access to healthcare for underserved, marginalized and vulnerable populations.
An important point is data collection: proCHWs play a crucial role in collecting health data from their communities to identify health trends, possible areas of intervention and potentially drive more effective national health policies.
Why is it important for CHWs to be fully integrated into health systems and be part of interdisciplinary teams?
CHWs are trusted by their fellow community members: they share their same cultural practices and this allows them to win the confidence of their neighbors. So, it is important for CHWs to be integrated into health systems because it allows for stronger collaboration and better coordination of care. For example, a CHW will be more likely to successfully persuade someone to overcome their misconceptions around certain vaccinations, medicines or hospital practices so that they can get the care they need. They can work with doctors and nurses to develop comprehensive care plans that address the unique needs of each patient, based on their knowledge of the individuals within their community.
Then there is skill diversity: different team members bring different skills, perspectives and areas of expertise, all of which contribute to quality of care. For example, when a nurse from semi-arid or arid land comes to work in Nairobi they don’t have direct experience of life in urban areas and the challenges faced by the people there. Insights from a CHW would be invaluable to make more informed decisions.
Finally, CHWs provide continuous care, reducing the gaps in healthcare delivery. In many regions facilities are extremely far from the patient’s home so it falls to the CHW to offer follow-up services.
What does CHIC still hope to achieve?
CHIC hopes to achieve the goal of having 40+ low and middle-income countries adopt proCHW best practices into their national policies, which will ultimately create a world where pro CHWs are the norm and can provide quality care to all those who need it. So far, 34 countries have adopted proCHW policies, so we still have some work to do. We want to equip international policymakers with relevant evidence and also want to influence global financing institutions to increase funding to CHWs. Additional funding would also help us to empower more CHWs through skills and advocacy training, either through equipping them with smartphones and data bundles or by bringing them to a classroom setting.
How does the recent launch of the Kenyan Government’s program to professionalize CHWs impact your work?
To me the program is a significant step towards achieving CHIC’s goals and it aligns with our mission to make proCHWs the norm. It also demonstrates the growing recognition of the importance of CHWs in the healthcare system. In terms of my daily work, I still feel there is a need to continue to advocate for adequate supplies for CHWs, as well as digital tools. We are also advocating to avoid deepening inequality: we applaud the government’s commitment to pay 50% of CHW salaries and are hopeful that county governments, as owners of community health programming, will be motivated to cover the other 50%. As CHIC's CHW Engagement Lead I am proud to work alongside CHW Advocates across Kenya as they form the first National Association for CHWs. This CHW-led association is best placed to hold the Kenyan Government to account and we will support them in this.
It is often said that “community health is the equity arm of primary care”. How do you think making community health a priority will help in making healthcare more equitable in Kenya?
CHWs play a critical role in reaching marginalized and underserved populations. Making community health a priority across the world, and in Kenya specifically, will undoubtedly help to bridge healthcare gaps, reduce disparities and ensure all individuals, regardless of their socioeconomic status, have access to quality health services.