The Financing Alliance for Health 240d ago

💭 “If we lack so much financing, why should we spend money on community health workers instead of highly trained professionals like doctors and nurses?” A powerful and critical question from the hashtag#CPHIA2025 audience — one that goes to the core of how we can reimagine health systems finance in Africa. As Shivani Shukla from the Financing Alliance for Health explained: “Community health came into the picture because low- and middle-income countries could not afford expensive healthcare systems. We needed workers who, though less formally trained, could reach communities where hospitals were few and far between — and still are in many areas today. Community health workers became the most cost-effective service delivery model — reaching places hospitals never could.” If we remove funding for community healthcare, how will we fill the gap in places where hospitals or advanced care remain out of reach — in the very areas where healthcare is most needed and least accessible? Her abstract presentation, “Vertical and Horizontal Trends in Financing Community Health Workers,” revealed striking insights from 20 years of data: 1️⃣ Between 2002 and 2022, Sub-Saharan Africa received US$11 billion in external assistance for CHW programs — 76% of all global CHW funding. 2️⃣ 76.4% of that went to vertical, single-disease programs, largely from a few funders. 3️⃣ From 2016–2022, 82.3% of CHW financing still came from external sources — a volatile trend that surged during COVID-19 but is now declining. She challenged us to all think: as global aid contracts, how do we protect the backbone of Primary Health Care — the community health worker — while ensuring sustainability and integration? Research shows CHW programs deliver a 10:1 return on investment, yet remain underfunded. Both community health and primary healthcare need financing — the challenge is to find the balance that makes delivery systems accessible, resilient, and sustainable. If we remove community health workers and focus only on nurses and doctors, how will we reach the people who live far from any facility? Who will serve the mother giving birth in a remote village, or the child who falls ill miles from the nearest clinic? Community health workers are the bridge — they bring the health system to the doorstep, where hospitals and high-level professionals cannot reach.