This technical taskforce report focuses on providing broad cost guidance, deployment strategy and operational design considerations for Community Health Worker (CHW) subsystems as part of health system strengthening to achieve the MDGs in Africa. These considerations are summarised in the following 5 themes:
- Tight linkages with appropriately-financed local primary health care systems are crucial to sustaining scale up of CHW subsystems, particularly with strong supervision from more clinically skilled health cadres.
- Development of operational designs for national deployment must be evidence-based, community responsive and context specific.
- Determining the basic costs associated with the core components of a CHW subsystem is necessary in order to inform the global community on financing gaps. This report provides a cost estimate for a paid, full-time CHW operational design targeting child, newborn and maternal health. The yearly cost for a phased rollout across rural low-income Sub Saharan Africa by 2015 is estimated to be US$6.56 per person served in rural areas or $2.62 per capita for a CHW subsystem, with a total CHW program cost of $3,584 per CHW. This results in a total of approximately US$2.3 billion per year, which includes existing expenditures from national governments and donors.
- Coordinated planning of deployment and training of CHWs at scale that takes into account strategies to support logistics, training, and monitoring and evaluation should result in strong, well-defined and responsive national and sub-national CHW subsystems.
- An overview of the current national policy and implementation landscape contextualises and targets subsequent support for CHW subsystem upgrades in partnership with national governments such as Nigeria, which is featured as a case study and partner in this report.