Community health workers play a critical role in meeting health needs and in contributing to stronger national health systems all over the world, including in countries in crises. Without them, we will never reach universal health coverage. It is time to invest in this critical link in the global health care workforce.
The critical role of community health volunteers
While investments in the strengthening of health systems have yielded impressive returns, progress towards universal health coverage — as enshrined in Goal 3 of the Sustainable Development Goals — has been highly variable. More than half of all maternal, new-born and child deaths occur in places where there is conflict, crisis and/or natural disasters. Too few children are protected through vaccination, often due to living in locations affected by conflict and natural disasters. Safe motherhood is far from universal. Maternal mortality accounts for 9.1% of all deaths among women aged between 15 and 49. Of the ten countries with the highest maternal mortality ratios, eight are crisis-affected and fragile states.
Health workers play a critical role in meeting health needs and in contributing to stronger national health systems all over the world. Red Cross or Red Crescent volunteers and other local actors bring an understanding of the context of unaddressed risks, of local cultures and practices, of vulnerabilities and inequalities that are critical if a communities physical and mental health is to improve. Many such workers (whether paid or volunteer) are not as highly trained as doctors or nurses, but they nevertheless play a critical role in improving public health outcomes, by providing services for which medical professionals cannot devote their time (such as community-based psychosocial support and health education, screening, management and follow up) and/or through their presence in areas where medical professionals are often inaccessible (such as rural areas, informal settlements and conflict zones).
This is particularly important in the area of health security and the detection and response to communicable diseases. The Ebola outbreak of 2014-15 shone a strong light on the many weaknesses of global capacity to stop pandemics. Despite the requirements of the International Health Regulations many states still lag behind in modernizing their systems. A critical gap is the lack of recognition/incorporation of the key role of local volunteers as the frontline pandemic workforce, as recognized in the Ebola review.
The cost of expanding the public health system using only the most highly trained and specialised medical professionals is untenable. Alternative, affordable strategies are essential to dramatically improving health care. Red Cross and Red Crescent volunteers are an important part of that alternative.
Our call to action
- We call on governments to :
- Fully integrate the role of community-based health workers in national public health plans and strategies, including in the areas of epidemic surveillance and control, non-communicable diseases, TB and malaria prevention and support, maternal and under-five care and psycho-social services.
- Where needed, include protocols on “task shifting” in relevant laws, regulations and medical codes to enable community-based health workers to provide services to hard to reach populations as relevant to their competence
- Take the necessary steps to implement their obligations under the International Health Regulations, in particular to invest in early alert and rapid response capacity in high risk communities, focusing on the community level and in partnership with local actors
- Recognise and promote the auxiliary role of National Societies in the area of public health, including through reference in relevant public health laws, policies and programmes
- We call on donors to:
- Ensure financing for community health volunteers as a means of achieving SDG 3, including in areas less accessible to governments and to establish flexible mechanisms to invest funds to whichever organisation has the best access to those in need and comparative advantage.
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