Abstract
ObjectiveTo estimate the level and trend of development assistance for community health worker-related projects in low- and middle-income countries between 2007 and 2017.MethodsWe extracted data from the Organisation for Economic Co-operation and Development’s creditor reporting system on aid funding for projects to support community health workers (CHWs) in 114 countries over 2007–2017. We produced estimates for projects specifically described by relevant keywords and for projects which could include components on CHWs. We analysed the pattern of development assistance by purpose, donors, recipient regions and countries, and trends over time.FindingsBetween 2007 and 2017, total development assistance targeting CHW projects was around United States dollars (US$) 5 298.02 million, accounting for 2.5% of the US$ 209 277.99 million total development assistance for health. The top three donors (Global Fund to Fight AIDS, Tuberculosis and Malaria, the government of Canada and the government of the United States of America) provided a total of US$ 4 350.08 million (82.1%) of development assistance for these projects. Sub-Saharan Africa received a total US$ 3 717.93 million, the largest per capita assistance over 11 years (US$ 0.39; total population: 9 426.25 million). Development assistance to projects that focused on infectious diseases and child and maternal health received most funds during the study period.ConclusionThe share of development assistance invested in the CHW projects was small, unstable and decreasing in recent years. More research is needed on tracking government investments in CHW-related projects and assessing the impact of investments on programme effectiveness.
Highlights
To attain universal health coverage for the most vulnerable populations and to prepare against future epidemics, such as Ebola, there have been calls for scaling-up community health worker (CHW) programmes.[1,2,3,4,5,6,7,8] The aim would be to address the unmet gap of health services caused by geographical, financial and sociocultural barriers in low-resource settings
A study has estimated that deploying CHWs in rural areas of subSaharan African countries requires at least 2.6 billion United States dollars (US$), funded either by national governments or donor partners or both.[20]
Of the total US$ 209 277.99 million development assistance disbursed to health over the period of the study, the percentage invested in CHW-targeted projects averaged 2.5% (US$ 5 298.02 million)
Summary
Country case studies have shown that CHWs can contribute to improving health outcomes for children, pregnant women and other patients.[1,2,3,4,5,6,9,10,11,12,13,14,15,16,17,18,19] To be effective, CHWs should be well-trained and well-supervised, given logistical support for the supplies and medications they deliver and provided with appropriate and regular financial incentives. Our literature review for this study demonstrates that the empirical evidence about existing investments is scant at best
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