A new philanthropic project hopes to invest $100 million in 10 countries, mostly in Africa, by 2030 to support 200,000 community health workers, who serve as a critical bridge to treatment for people with limited access to medical care.
The Skoll Foundation and The Johnson & Johnson Foundation announced Monday that they donated a total of $25 million to the initiative. The Global Fund to Fight AIDS, TB and Malaria, which will oversee the project, matched the donations and hopes to raise an additional $50 million.
The investment seeks to empower the front-line workers that experts say are essential to battling outbreaks of COVID-19, Ebola and HIV.
Ashley Fox, an associate professor specializing in global health policy at Albany, SUNY, said evidence shows community health workers can effectively deliver low-cost care “when they are properly equipped and trained and paid – that’s a big caveat."
Though the current number of these workers is not well documented, in 2017, the Africa Centers for Disease Control and Prevention estimated that the continent required 2 million to meet health targets. Many of these workers are women and unpaid, though The Global Fund advocates for some sort of salary for them.
“It’s hard to think of a better set of people that you would want to be paying if you think about it from both the point of view of creating good jobs as well as maximizing the health impact,” said Peter Sands, the fund's executive director.
The Global Fund, founded in 2002, channels international financing with the aim of eradicating treatable infectious diseases. In addition to its regular three-year grants to countries, it will deploy these new philanthropic donations through a catalytic fund to encourage spending on some of the best practices and program designs.
“What have we found out in terms of community health workers?” said Francisca Mutapi, a professor at the University of Edinburgh, who helps lead a multiyear project to treat neglected tropical diseases in multiple African countries. “They are very popular. They are very effective. They are very cost effective.”
Along with the other organizations that specialize in the financing, research and policy of public health, they set about designing an initiative to expand community health programs and to capitalize on the attention the pandemic brought to the need for disease surveillance.
Last Mile Health won a major donation from the Skoll Foundation in 2017 and has also received large donations from the Audacious Project from TED and Co-Impact, another funding collective. The organization's co-founder, Raj Panjabi, now serves in the Biden administration.
The Global Fund said it will assist countries with the design of proposed community health care worker expansions over the next year.
Chen acknowledged there is no silver bullet for the issue of sustainability.
“Part of the work that organizations like Last Mile Health have to do is to sit in that discomfort and wrestle with it, with our partners, with donors, until we incrementally squeeze out the solution here,” Chen said.
Mutapi said eventually governments must fund the programs themselves and she argued the experiences of places like Zimbabwe and Liberia with community health workers could benefit people in other contexts as well.
“Actually, having lived on Scottish islands, which are inaccessible,” she said, the innovation of community health workers is “something that actually can be exported to Western communities that are remote because that connection between a health provider and the local community is really important for compliance and for access.”