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Above: A mother of six children in Mozambique discusses nutrition and family planning with a community health worker at her home. (Courtesy of Kate Holt/Jhpiego)

Connecting the disconnect: Community health and health systems strengthening

Posted March 28, 2017

This blog originally appeared on The Huffington Post.

Universal health coverage and the Sustainable Development Goals have reinvigorated global focus and attention toward primary health care, bringing us back to Alma-Ata and the commitment to Health for All.  The 24 countries convening in Johannesburg this month for the Institutionalizing Community Health Conference will lead the way for re-prioritizing community health and help close the health worker gap.

The lack of integration and linkages with the health system means many community health worker (CHW) programs have waned and failed to scale. The conference will highlight the links between community engagement, communities, and the primary health care system. It will also highlight the need to include CHW programmatic and management support in human resource strategies and through supervision systems and performance management.

But this is just the beginning of a longer journey. We need more than the integration of community health approaches into national health policy and systems. To fulfill the need for action under Alma Ata to protect and promote the health of all people, we need to prioritize an integrated approach to primary health.

“Resilience” was a term used to describe successful health systems at the Fourth Global Health Systems Symposium in Vancouver. Resilience is also what we want to see in communities. However, we cannot separate the conversations between health systems, universal primary health care, and community health.

The responsibility of primary health does not lie with the community or the community health worker or the health system alone. It relies and depends on all of them. Primary health needs a well-equipped district health system and hospital; a functional first level of care facility; and a community health worker who feels supported and confident. Moreover, it depends on the trust and support from CHW supervisors and communities to make it sustainable. Community health workers are a key node in the health system chain, but without a coordinated system strengthening approach, they will fail to achieve what they are uniquely well poised to achieve: the delivery of community-based primary health care.

As we gear up for the first Institutionalizing Community Health Conference, let’s not talk about CHWs as a “magic bullet” to fix community health problems; instead, let’s think about the eco-system. Let’s take the time to discuss the policies that will allow frontline health workers to be supported, recognized and paid for their efforts. Let’s talk about their work load and how supervisors and communities can support this cadre. And let’s discuss budgets and buy-in at the national and the district level so that CHWs benefit from supportive infrastructure, including a functioning and staffed referral clinic, resources for supervision, trainings, equipment and supplies, and a work place free of harassment.

Let’s think about the entire system of health and communities and, together, work to remove the disconnect. We must implement and advocate for ways to support this unsung cadre, which will likely be the lynchpin in our journey toward achieving universal health coverage and the Sustainable Development Goals.

As we forge the way ahead towards a sustainable, universal, healthy future, we owe it to those on the front lines to learn from our past and drive change upstream.


Maternal and Child Survival Program