A new philanthropic project hopes to invest $100 million in 10 countries, mostly in Africa, by 2030 to support 200,000 community health workers, who serve as a critical bridge to treating people with limited access to health care.
The Skoll Foundation and the Johnson & Johnson Foundation announced Monday that they have donated a total of $25 million to the initiative. The Global Fund to Fight AIDS, Tuberculosis and Malaria, which will oversee the project, has matched the donations and hopes to raise an additional $50 million.
The investment seeks to empower frontline workers who experts say are essential to combating outbreaks of COVID-19, Ebola and HIV.
“What have we discovered in terms of community health workers?” said Francisca Mutapi, a professor at the University of Edinburgh, who helps lead a multi-year project to treat neglected tropical diseases in several African countries. “They are very popular. They are very effective. They are very profitable.”
On a recent research trip to Zimbabwe, Mutapi described how a community health worker negotiated treatment for a parasitic infection in a young boy who was part of a religious group that does not accept clinical medicine.
“She goes to the river, goes about her daily activities, and notices that one of the children in her community is complaining of a stomachache,” Mutapi said.
The woman approached the boy’s grandmother for permission to take him to a clinic, which diagnosed and began treating the boy for bilharzia. That would not have happened without the woman’s intervention, Mutapi said.
Ashley Fox, an associate professor who specializes in global health policy at Albany, SUNY, said evidence shows that community health workers can effectively deliver low-cost care “when they’re properly equipped, trained and paid, that’s a big warning.
Although the current number of these workers is not well documented, in 2017 the Africa Centers for Disease Control and Prevention estimated that the continent needed 2 million to meet health targets. Many of these workers are women and do not receive a salary, although the Global Fund advocates some type of salary for them.
“It’s hard to think of a better group of people you’d like to pay if you think about it both from the standpoint of creating good jobs and maximizing the health impact,” said Peter Sands, the fund’s executive director. . .
The Global Fund, founded in 2002, channels international funding with the goal of eradicating treatable infectious diseases. In addition to its regular three-year grants to countries, it will roll out these new philanthropic gifts through a catalytic fund to encourage spending on some of the best practices and program designs.
Last Mile Health, part of the Africa Frontline First health initiative, has worked with the Liberian government to expand and strengthen its community health program since 2016.
In the early months of the COVID-19 pandemic, former Liberian President and Nobel Peace Prize winner Ellen Johnson Sirleaf called on Last Mile Health and other organizations to deal with a response.
“We were all seeing the moment of deja vu as we looked back a couple of years ago when Liberia was beset by this tragic Ebola epidemic,” said Nan Chen, CEO of Last Mile Health. “And as Chair Sirleaf reminded us: the tide turned when we addressed the community.”
Along with the other organizations that specialize in public health funding, research, and policy, they set out to design an initiative to expand community health programs and capitalize on the attention the pandemic brought to the need for disease surveillance.
The catalytic fund is the result. “I think the pandemic has shone a light on the critical role of these healthcare workers,” said Lauren Moore, Johnson & Johnson’s vice president of global community impact.
Don Gips, executive director of the Skoll Foundation, emphasized that these workers can also generate early warnings that benefit people everywhere.
“It’s critical not only to deliver health care in Africa, but that’s how we’ll also detect the next set of diseases that could threaten populations around the world,” said Gips, who is also a former US ambassador to South Africa.
Last Mile Health won a major grant from the Skoll Foundation in 2017 and also received large grants from TED’s Audacious Project and Co-Impact, another funding group. The organization’s co-founder, Raj Panjabi, now serves in the Biden administration.
“What philanthropy has noticed about Last Mile Health is that we were not only taking direct action on the problem by actively managing community health worker programs, but we were seeing our innovation adopted in national policy through scale,” said James Nardella, director of the organization. program manager.
SUNY’s Fox and other experts say linking the work of community health workers to the national health system is a priority, along with ensuring sustainable funding for their programs.
The Global Fund said it will help countries with the design of proposed community health care worker expansions over the next year.
Chen acknowledged that there is no panacea for the issue of sustainability.
“Part of the job that organizations like Last Mile Health have to do is sit in that discomfort and wrestle with it, with our partners, with donors, until we can find the solution here,” Chen said.
Mutapi said governments must eventually fund the programs themselves, and argued that the experiences of places like Zimbabwe and Liberia with community health workers could also benefit people in other contexts.
“Actually, having lived on the Scottish islands, which are inaccessible,” he said, the community health worker innovation is “something that can actually be exported to Western communities that are remote because that connection between a healthcare provider health and the local community is really important. for compliance and for access.”
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