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Professionalisation of Community Health Workers: Time for a Formal Contract

Author

Listed:
  • Adriana Viola Miranda
  • Rizky Deco Praha
  • Trio Sirmareza
  • Rizky Aditya
  • Ryan Rachmad Nugraha
  • Maritta Rastuti
  • Rindang Asmara
  • Zack Petersen
  • James O'Donovan

Abstract

Community health workers (CHWs) are the backbone of strong primary healthcare systems. If properly supported, they can add significant value to access to healthcare service delivery. Yet, despite their proven effectiveness globally, systemwide support for CHWs remains sub‐optimal. This study explores the concept of ‘proCHW’ programs ‐ where CHWs are skilled, supplied, supervised and salaried. We suggest a fifth component is added to this framework—security (defined as formal contracts). Currently, many CHWs work voluntarily without any formal contract, rendering them vulnerable to sudden replacements. Therefore, institutionalising formal contracts will provide legal safeguards for CHWs, ensuring fair and safe employment conditions, including a minimum wage and opportunities for career advancement. To enable funding for establishing formal contracts for CHWs, strong political commitment, public‐private partnerships, and tailored funding strategies based on local administrative systems are needed. By addressing these challenges, sustainable funding can be achieved, maximising the impact of CHW‐led programs and improving primary health care globally.

Suggested Citation

  • Adriana Viola Miranda & Rizky Deco Praha & Trio Sirmareza & Rizky Aditya & Ryan Rachmad Nugraha & Maritta Rastuti & Rindang Asmara & Zack Petersen & James O'Donovan, 2025. "Professionalisation of Community Health Workers: Time for a Formal Contract," International Journal of Health Planning and Management, Wiley Blackwell, vol. 40(3), pages 783-787, May.
    • Handle: RePEc:bla:ijhplm:v:40:y:2025:i:3:p:783-787
    DOI: 10.1002/hpm.3897
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    References listed on IDEAS

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    1. Maes, Kenneth & Closser, Svea & Tesfaye, Yihenew & Abesha, Roza, 2019. "Psychosocial distress among unpaid community health workers in rural Ethiopia: Comparing leaders in Ethiopia's Women's Development Army to their peers," Social Science & Medicine, Elsevier, vol. 230(C), pages 138-146.
    2. James Andreoni & Michael Callen & Karrar Hussain & Muhammad Yasir Khan & Charles Sprenger, 2023. "Using Preference Estimates to Customize Incentives: An Application to Polio Vaccination Drives in Pakistan," Journal of the European Economic Association, European Economic Association, vol. 21(4), pages 1428-1477.
    3. Janna M Schurer & Kelly Fowler & Ellen Rafferty & Ornella Masimbi & Jean Muhire & Olivia Rozanski & Hellen J Amuguni, 2020. "Equity for health delivery: Opportunity costs and benefits among Community Health Workers in Rwanda," PLOS ONE, Public Library of Science, vol. 15(9), pages 1-18, September.
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    Cited by:

    1. Roosa Sofia Tikkanen, 2025. "Professionalisation of Community Health Workers: Formalisation as a Second Pillar of Job Security," International Journal of Health Planning and Management, Wiley Blackwell, vol. 40(4), pages 1013-1014, July.

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