title: Community health workers for universal health-care coverage: from fragmentation to synergy.
abstract: To achieve universal health coverage, health systems will have to reach into every community, including the poorest and hardest to access. Since Alma-Ata, inconsistent support of community health workers (CHWs) and failure to integrate them into the health system have impeded full realization of their potential contribution in the context of primary health care. Scaling up and maintaining CHW programmes is fraught with a host of challenges: poor planning; multiple competing actors with little coordination; fragmented, disease-specific training; donor-driven management and funding; tenuous linkage with the health system; poor coordination, supervision and support, and under-recognition of CHWs' contribution. The current drive towards universal health coverage (UHC) presents an opportunity to enhance people's access to health services and their trust, demand and use of such services through CHWs. For their potential to be fully realized, however, CHWs will need to be better integrated into national health-care systems in terms of employment, supervision, support and career development. Partners at the global, national and district levels will have to harmonize and synchronize their engagement in CHW support while maintaining enough flexibility for programmes to innovate and respond to local needs. Strong leadership from the public sector will be needed to facilitate alignment with national policy frameworks and country-led coordination and to achieve synergies and accountability, universal coverage and sustainability. In moving towards UHC, much can be gained by investing in building CHWs' skills and supporting them as valued members of the health team. Stand-alone investments in CHWs are no shortcut to progress.
authors.affiliation: Capacity Plus , IntraHealth, 1776 I St, NW, Washington, DC 20006, United States of America (USA).
authors.forename: Kate
authors.initials: K
authors.lastname: Tulenko
authors.affiliation: Norwegian Knowledge Center for the Health Services, Oslo, Norway .
authors.forename: Sigrun
authors.initials: S
authors.lastname: Møgedal
authors.affiliation: Global Health Workforce Alliance, Geneva, Switzerland .
authors.forename: Muhammad Mahmood
authors.initials: MM
authors.lastname: Afzal
authors.affiliation: United States Agency for International Development, Washington, USA .
authors.forename: Diana
authors.initials: D
authors.lastname: Frymus
authors.affiliation: Federal Ministry of Health, Abuja, Nigeria .
authors.forename: Adetokunbo
authors.initials: A
authors.lastname: Oshin
authors.affiliation: Federal Ministry of Health, Abuja, Nigeria .
authors.forename: Muhammad
authors.initials: M
authors.lastname: Pate
authors.affiliation: United States Agency for International Development, Washington, USA .
authors.forename: Estelle
authors.initials: E
authors.lastname: Quain
authors.affiliation: Genos Global, Panama City, Panama .
authors.forename: Arletty
authors.initials: A
authors.lastname: Pinel
authors.affiliation: Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland .
authors.forename: Shona
authors.initials: S
authors.lastname: Wynd
authors.affiliation: Public Health Foundation of India, New Delhi, India .
authors.forename: Sanjay
authors.initials: S
authors.lastname: Zodpey
mesh_terms: D057191:Capacity Building / Q000458:organization & administration*; D003150:Community Health Workers / Q000193:education / Q000458:organization & administration*; D014943:Global Health; D006297:Health Services Accessibility / Q000458:organization & administration*; D006301:Health Services Needs and Demand; D006280:Health Workforce / Q000458:organization & administration*; D006801:Humans