At least six million women – often in low- and middle-income countries – work in community health centers for little or no pay. Many work as community health workers (CHWs). However, although these are skilled tasks that should be paid, only 34 countries register, train and offer salaries to CHWs.
Most of these workers are exploited, which reduces their effectiveness towards patients. If we are serious about making “health for all” a global priority, this must change.
CHWs are critical to strengthening national health systems: they are proven to improve maternal and child health services, expand access to family planning, and support the prevention and treatment of both infectious and chronic diseases. not transferable. If CHW were deployed to 30 vital health services in countries with the highest disease burden, 6.9 million lives could be saved each year and child mortality could be reduced by almost half. Furthermore, the Covid-19 pandemic has shown that resilient community health programs can provide essential services even in situations of great adversity.
But these programs can only reach their full potential if services are designed according to evidence-based best practices. This means treating CHWs as professionals who need training, fair compensation and safe working conditions. When CHWs are used as a stopgap measure or source of cheap labor, they are less effective than their well-resourced counterparts.
In Africa, up to 85% of community health workers are unpaid, and globally a third of the time they do not have the medicines they need to do their work.
In Africa, up to 85% of CHWs are not paid, and globally a third of the time they do not have the necessary medication to do their work. There is a shortage of health workers in our home country of Uganda, so CHWs are the ones who have filled this gap. Although these workers provide vital services to their communities and perform many of the same duties as their employed supervisors, their compensation is often minimal or non-existent.
Why are CHWs, who are often Black women, expected to work and save lives without being recognized or compensated? Obviously, this is also a question of gender rights. Patriarchal norms and power dynamics force women to accept very low wages and even work unpaid. For example, women from low-income, low-education households often see this type of unpaid work as an opportunity to gain access to paid jobs or to items such as cell phones or bicycles. Unpaid work in healthcare can also give women social recognition. In many contexts, it is viewed as honorable work that families find acceptable for women. Therefore, CHWs often juggle combining these positions with occasional paid work and family responsibilities.
These women face an unenviable dilemma: If they leave their CHW jobs to seek full-time employment to support themselves, who will provide much-needed health care in their communities? They are cornered by systemic inequalities and traditional gender roles and often push themselves further, sacrificing their stability, economic security, career development and well-being.
Obviously, this is also a question of gender rights. Patriarchal norms and power relations force women to accept very low salaries and even work without pay
To eliminate this deep-rooted social and economic injustice, the professionalization of CHWs must be the norm and not the exception. At a minimum, CHWs must be registered to ensure certain standards are met, are paid competitive salaries, and receive ongoing training and support from designated supervisors. and integrate them into health systems (including primary health care facilities and broader monitoring and evaluation systems). This allows them to conduct proactive monitoring and see patients at points of care without incurring any costs.
In short, CHWs must be paid, trained, supervised and provided with necessary inputs.
After years of marginalization and isolation, CHWs are organizing and establishing national networks, largely using digital technologies, to achieve these goals. More than 5,000 collaborating health professionals and organizations in 40 countries have come together as part of the Community Health Impact Coalition to translate collaborative research and advocacy work into policy changes at the national level. Our shared mission is to ensure that all low- and middle-income countries – including Uganda – take action to professionalize CHWs.
The international community must decide whether to adequately compensate those who have supported the health systems of low- and middle-income countries for decades or continue to exploit a predominantly female workforce. The moral alternative is clear: Countries that professionalize CHWs and integrate them into a robust health infrastructure will be better able to achieve “health for all,” including the women who provide most of the care.
Lennie Bazira is policy director for the Community Health Impact Coalition. Prossy Muyingo is a community health worker in Uganda. She received the 2023 Health Heroine Award from Women in Global Health.
Spanish translation by Ant-Translation
Copyright: Project Syndicate, 2023. www.project-syndicate.org
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