The potential of a “next generation” of community health workers to accelerate progress in reaching Universal Health Coverage and Health for All

Many health systems, particularly in low- and lower middle-income countries (LMICs), are lagging in their progress in achieving Universal Health Coverage and delivering on the promise of Health for All, constrained by workforce shortages, fiscal ceilings, and inadequate outreach to those lacking basic and essential services. Stark inequities in coverage of services and in health status persist. Strengthening community health worker (CHW) programs provides the fastest and most cost-effective route for health systems to achieve their full potential. CHWs should become the backbone of primary health care (PHC) and the foundation of health systems. Evidence from more than a decade of national-scale experience demonstrates that CHWs who are appropriately trained, paid, equipped, and supervised can extend high-quality essential services to the last mile while improving the overall efficiency of the health system. We are at a point in time when donor strategies and private investment are captivated by the promise of digital health and artificial intelligence. The most reliable approach to saving more lives is still a paid, supported CHW empowered with digital tools. At the same time, the contraction of Official Development Assistance (ODA) creates both risk and opportunity. ODA must pivot from supporting services to catalytic capital: time-bound, matching investments that accelerate governments’ own proCHW policy. A “next generation” of CHW programs in LMICs would enable CHWs to visit every home monthly and provide a broad array of PHC services as a result of adequate remuneration and appropriate training, supervision, logistical support, and integration into the health system. This could yield a highly favorable economic return—through productivity gains from better health, reduced health-care expenditures, and pandemic-risk mitigation. A “next generation” of CHW programs is our best bet for accelerating progress in achieving Universal Health Coverage and Health for All sooner rather than later.