How can we build sustainable large-scale national CHW programs?

1. How can we build sustainable large-
scale national CHW programs?
Henry Perry, MD, PhD, MPH
Senior Scientist
Johns Hopkins Bloomberg School of
Public Health

2. Overview
• Historical perspectives on large-scale CHW programs
• Financial sustainability of large-scale CHW programs
– Evidence on financing of CHW programs
• Return on investment in CHWs
• The proposed Financing Alliance for Health
• The way forward

3. Historical perspective
• Programs in the 1970s and 1980s not well
planned
– Inadequate supervision and logistical support
– Lack of evidence of program effectiveness (no
ongoing M&E or gradual program strengthening)
– Lack of political support to sustain costs
• Competition with funding for curative care
and funding for higher-level facilities

4. Financing of CHWs as a political
problem
• Government investments in health care
traditionally not seen as a good financial
investment
• Ministries of health lack political clout with
the finance ministry
• Health systems investments focused on less
productive investments (particularly higher-
level facility-based care – “hospital centrism”)

5. Hospital-centrism: health systems built
around hospitals and specialists
Source: MOH, Republic of Ghana, A Primary Health Care Strategy for Ghana, 1978

6. Available at:
http://www.mchip.net/sites/default/files/MCHIP_CHW%20Ref%20Guide.pdf

11. Return on investment in CHWs – 10:1
• Improvement in health status (and increased worker
productivity)
• Reduced risk of pandemic or “Ebola-like” events
• Savings in the health system by making services
cheaper
• Broader social benefits (income for CHWs and their
poor families; women’s empowerment; registration
of vital events)

12. The proposed Financing
Alliance for Health
• Serve as catalytic link between ministries of
health and global stakeholders (banks,
investors, international finance institutions)
• Provide support for the short-to-medium term
as donor support diminishes and before
countries ready to shoulder the full cost of
CHW operations
• Have its technical home in the International
Institute for Primary Health Care in Ethiopia

13. 13
A partnership to support governments in rapidly financing and scaling CHW programs
Mission
• Work with national and sub-national governments to support the design and funding of
ambitious, affordable, and at-scale community health systems, including funding through
innovative financing pathways and investments.
Value
proposition
• Commitment to partnering with governments and building local capacity
• Expertise in financing, action-oriented nature, commitment to the ten guiding principles
established in the CHW Investment Case Report
Types of
support
• Financing support: ROI advisory, financial advisory & execution
• Scale-up strategy support: overall plan design, model refinement & expansion, targeted
technical support
• Knowledge management and capacity development: south-south dialogues on guiding
principles, insights on existing pathways, capturing experiences
Core partners
• UNICEF, the UN Special Envoy’s Office, and the MOH Ethiopia are the core partners
driving forward this work
• World Bank, PIH, Last Mile Health, CHAI, and JHU also involved
• Core partners asked to dedicate capacity and help engage countries
COMMUNITY HEALTH FSU MISSION AND SUPPORT

14. The way forward
• We need a big boost of at least $1 billion from
international donors to move the CHW agenda
forward (Jeff Sachs)
• We need continued evidence of effectiveness and
cost-effectiveness of large-scale CHW programs
(Henry Perry)
• We need to build national political support for
CHW programs (Henry Perry)
• We need multiple sources of financial support
rather than rely on a single source (Henry Perry)