‘Underfunded and overlooked’: just 1 in 3 community health programs receive government funding in the Middle East and North Africa

AMMAN, 12 December 2024 – Children in the Middle East and North Africa would be better served by community health programs if they were properly funded and included in national health systems, according to a new UNICEF report launched today.

Community-based primary health care is the cornerstone of a strong, sustainable and equitable health system on the pathway to universal health coverage. The community health workers who deliver services, such as vaccination, antenatal and postnatal care, screening children for severe malnutrition, hygiene and sanitation are primarily female volunteers who act as a bridge between vulnerable families and the health and nutrition services they need.

A UNICEF analysis of community health in 12 countries[1] and one subnational setting[2] found that far more could be done to support community health systems and workers and improve health outcomes for children.

Of the 12 countries analysed, only four reported providing domestic funding for community health and only five countries reported recognition of community health workers as part of the national health workforce.

“Community-based health care is massively underfunded in the Middle East and North Africa,” said UNICEF Middle East and North Africa Regional Director Edouard Beigbeder.

“Despite this, these front-line health-care workers – mostly women – are delivering vital health and nutrition services that save lives. As trusted members of the community, they understand the community’s values and the challenges it faces. They must be better supported, paid and recognized for this important work.”

The report underscores that strong community-based primary health-care systems led by professional community health workers who are paid fairly and protected and supported in their work can improve health outcomes, especially for marginalized or hard-to-reach communities, such as refugees. Positively, in nine out of the 12 countries , refugees or internally displaced people were either providing or receiving community health services.

Investment can benefit governments too. Global analysis has shown that governments can generate up to a $10 return for every $1 invested into community health, due to the number of deaths prevented, the high costs of health crises avoided and the economic impact of higher employment, especially for women.

In the Middle East and North Africa, there are at least 204,000 community health workers, with many more unaccounted for by national reporting because they are volunteers or are funded by community organisations on a project-by-project basis.

To improve health outcomes for every child, UNICEF is calling for governments to:

1. Develop prioritized national and subnational community health strategies and increase budget allocations to strengthen community health systems
2. Recognize and integrate community health workers into national health systems, including by adopting standardized and sustainable approaches to employing and paying community health workers
3. Invest in formal social accountability mechanisms that allow communities to engage and provide feedback on health services, monitor service quality and assess performance through structured feedback systems
4. Reflect gender sensitive practices in community health policies and programmes
5. Improve the coordination and formalization of multisectoral collaboration to strengthen community health, including for emergency preparedness and response

“Community health workers should be integrated into the health-care workforce across the region, but especially wherever health and nutrition needs remain unmet,” said Beigbeder. “There is no doubt that investing in community health workers and strengthening community-based primary health care, including nutrition, pays dividends – both for children and for countries.”

[1] Algeria, Djibouti, Egypt, Islamic Republic of Iran, Iraq, Jordan, Lebanon, Libya, Morrocco, Sudan, Tunisia, Yemen

[2] Northwest Syria