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 treatment for people with limited access to medical care.

The Skoll Foundation and The Johnson & Johnson Foundation announced Monday that they donated a total of $25 million to the initiative. The Global Fund to Fight AIDS, TB and Malaria, which will oversee the project, matched the donations and hopes to raise an additional $50 million.

The investment seeks to empower the front-line workers that experts say are essential to battling outbreaks of COVID-19, Ebola and HIV.

“What have we found out in terms of community health workers?” said Francisca Mutapi, a professor at the University of Edinburgh, who helps lead a multiyear project to treat neglected tropical diseases in multiple African countries. “They are very popular. They are very effective. They are very cost effective.”

On a recent trip to Zimbabwe for research, Mutapi described how a community health worker negotiated the treatment of a parasitic infection in a young child who was part of a religious group that doesn’t accept clinical medicine.

“She’s going to the river, getting on with her day-to-day business, and she notices that one of the children in her community is complaining about a stomachache,” said Mutapi.

The woman approached the child’s grandmother for permission to bring the child to a clinic, which diagnosed and began treating the child for bilharzia. That would not have happened without the woman’s intervention, Mutapi said.

Ashley Fox, an associate professor specializing in global health policy at Albany, SUNY, said evidence shows community health workers can effectively deliver low-cost care “when they are properly equipped and trained and paid – that’s a big caveat.”

Though the current number of these workers is not well documented, in 2017, the Africa Centers for Disease Control and Prevention estimated that the continent required 2 million to meet health targets. Many of these workers are women and unpaid, though The Global Fund advocates for some sort of salary for them.

“It’s hard to think of a better set of people that you would want to be paying if you think about it from both the point of view of creating good jobs as well as maximizing the health impact,” said Peter Sands, the fund’s executive director.

The Global Fund, founded in 2002, channels international financing with the aim of eradicating treatable infectious diseases. In addition to its regular three-year grants to countries, it will deploy these new philanthropic donations 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 Noble Peace Prize recipient, Ellen Johnson Sirleaf, convened Last Mile Health and other organizations to grapple with a response.

“We were all kind of seeing the Deja vu moment of recalling back to a couple of years ago where Liberia was beset by this tragic epidemic of Ebola,” said Nan Chen, managing director of Last Mile Health. “And as President Sirleaf reminded us: the tide was turned when we turned to the community.”

Along with the other organizations that specialize in the financing, research and policy of public health, they set about designing an initiative to expand community health programs and to 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 health workers,” said Lauren Moore, vice president of global community impact at Johnson & Johnson.

Don Gips, CEO of the Skoll Foundation, emphasized that these workers also can raise early warnings that benefit people everywhere.

“It’s critical not just for delivering health care in Africa, but this is how we’ll also catch the next set of diseases that could threaten populations around the world,” said Gips, who is also the former U.S. ambassador to South Africa. 

Last Mile Health won a major donation from the Skoll Foundation in 2017 and has also received large donations from the Audacious Project from TED and Co-Impact, another funding collective. 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 that we were seeing our innovation adopted in national policy at scale,” said James Nardella, the organization’s chief program officer.

SUNY’s Fox and other experts say linking the work of community health care workers to the national health system is a priority, along with securing sustainable funding for their programs.

The Global Fund said it will assist countries with the design of proposed community health care worker expansions over the next year.

Chen acknowledged there is no silver bullet for the issue of sustainability.

“Part of the work that organizations like Last Mile Health have to do is to sit in that discomfort and wrestle with it, with our partners, with donors, until we incrementally squeeze out the solution here,” Chen said.

Mutapi said eventually governments must fund the programs themselves and she argued the experiences of places like Zimbabwe and Liberia with community health workers could benefit people in other contexts as well.

“Actually, having lived on Scottish islands, which are inaccessible,” she said, the innovation of community health workers is “something that actually can be exported to Western communities that are remote because that connection between a health provider and the local community is really important for compliance and for access.” 
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