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Community Health Workers

The Drive for One Million CHWs in Sub-Saharan Africa

The role of Community Health Workers (CHWs) in developing lands continues to grow, aided by technological advances such as mobile devices and point-of-care diagnostic kits. A campaign to create one million CHWs in sub-Saharan Africa has contributed to calls for CHWs to have an integral role in the future of formal healthcare in the region.

February 26, 2015

The Drive for One Million CHWs in Sub-Saharan Africa
After the Millennium Development Goals (MDGs) were established in 2000, there were extensive discussions around the world about how the usually unpaid community-based healthcare workers in developing lands might form an effective force to help attain various MDG targets. As a result, a more formalized role for Community Health Workers (CHWs) emerged, and since 2000, the CHWs themselves have evolved from a loosely-organized volunteer force into a highly-organized and well-trained interface between rural communities and the formal healthcare sector.¹

During the last decade, the advances and penetration of mobile technologies and the development of simple point-of-care diagnostic kits have greatly enhanced the role of CHWs and have expanded the range of services that they can provide.1 Consequently, CHWs have had a demonstrable impact on MDGs 4, 5, and 6 in many parts of Africa, where high infant and maternal death rates had previously remained refractory to interventions. ²³


In sub-Saharan Africa, where 10–20% of children die before the age of 5 years, a child presenting with a fever in a rural community can quickly become a life or death situation. ²³ The local CHW, who may have been alerted to visit the household in one of several ways, immediately uses a simple diagnostic test for malaria, which is part of the standard CHW supply kit.3 If the test is positive, the results are recorded using a mobile phone, and mobile technology provides medication advice and alerts the primary healthcare system. Around 30 minutes after arriving in a household, the CHW is able to administer first-line malaria treatment to the sick child. If the malaria test is negative, the child is immediately referred to a clinic for further investigations.

A key turning point in the development of the CHW system was reached in 2011, when a Technical Task Force was set up at the Earth Institute at Columbia University, New York, USA, to investigate how the CHW model could be scaled up to expand not only the number of CHWs but also their degree of integration into healthcare systems.2 The seemingly ambitious goal of training and deploying 1 million CHWs in sub-Saharan Africa by 2015 was born. ²

Since each CHW can serve a rural community of around 650 people, the estimated costs incurred would amount to just US$6.58 per patient per year, which is considered to be within the scope of governmental budgetary constraints combined with the donor assistance that has already been pledged.⁴

Importantly, the Earth Institute report emphasizes the need to view CHWs not as an adjunct to formal healthcare systems, but as a crucially important subsystem of the formal healthcare infrastructure that needs to be an integral part of the next generation of primary healthcare delivery.¹²

If the momentum created by the 1 million CHW campaign can be maintained, sub-Saharan Africa will be well placed to move beyond the 2015 MDG deadline and achieve the future healthcare goals that will be set for the coming decades.



1. Singh P, Sachs JD. 1 million community health workers in sub-Saharan Africa by 2015. Lancet. 2013;382:363-5.
2. Singh P for Technical Task Force. 1 million community health workers: global technical taskforce report. (accessed 10 December 2014)
3. Sachs JD, Singh P. The One-Million Community Health Worker Campaign. Global Health and Diplomacy.
4. One Million Community Health Workers. (accessed 10 December 2014)

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