These are the community health workers who are the heartbeat of global primary health care
Discover the challenges they face as they try to reach the most vulnerable children worldwide.
In every corner of the globe, community health workers – the majority of whom are women - are key to the success of vaccination and primary care health services. We know that when health services are designed and delivered by members of the communities they serve, they’re far more likely to prove successful. If we’re going to reach children from historically marginalized and underserved communities, it’s imperative that the presence, skills and motivation of these community health workers is strengthened.
Why are community health workers best positioned to deliver the health services that children need to thrive? They’re able to break down barriers, speak their community’s language and make sure that services address the most important needs of the families they serve. They’re able to engage with hesitant caregivers and help correct misinformation that has increasingly impacted immunization services. And through their extensive local knowledge, community health workers are able to provide essential information on the location of hard-to-reach children.
As community health workers, women are so often on the frontline
Globally, female community health workers are working tirelessly to reach out to communities and immunize children, in addition to providing other essential primary health care services. Kamala, Maria, Sadiya and Bahareh are among the remarkable community health workers who bring essential services to children and mothers in Nepal, Ecuador, Afghanistan and Nigeria. These are their stories:
In many parts of the world, women are best placed to reach out to other women and children – a population out-of-reach for men because of social, gender and cultural norms.
UNICEF/UN0648263/Sayed Bidel
UNICEF/UN0648278/Sayed Bidel
These health workers often work in remote and underserved areas, serving as a bridge between families and the community as a whole.
Despite recognition of their indispensable efforts, these community health workers are rarely equipped to deliver to their full potential. Health worker Ghada Ali Obaid lives in Yemen. For her, vaccinating children is not a job. It’s a calling. But like so many others, you’ll learn that she faces extensive challenges to reach the children that need her most.
In Yemen, alleviating suffering is motivating a vaccinator and midwife
On any average day, you’ll find Ghada Ali Obaid dashing through the hallways of Dar Sa’ad Medical Compound in the city of Aden, Yemen, counselling mothers about the benefits of immunization and vaccinating their children. She also takes to the streets to reach out to children who might otherwise miss vaccines against preventable diseases.
UNICEF/UN0679465/Saleh Hayyan
“The essence of our work is saving peoples’ lives and reducing the suffering of women and children,” Ghada says. “Personally, this is the most significant indicator of success in my work and life.”
Ghada is part of a corps of women in Yemen whose life’s work is to be the first line of defense against vaccine-preventable diseases.
The work has challenges. The health centre lacks medical staff, an issue she attributes to the lack of job incentives, rewards and promotions.
Ghada also struggles to find a balance between work and family. She works at the health centre in the morning and heads to remote locations in the afternoon. Finding that balance is possible with support from her husband Ehab Faisal. He takes time off from his job as a taxi driver to bring Ghada to these communities.
“Ghada’s job is a calling more than an occupation. I encourage her to show up every day because she is so passionate about it, and she has my full respect.”
A global shortage in community health workers is a gender issue
In most parts of the world, community health workers are often low-paid and denied opportunities for training and professional growth. And we know that most community health workers globally are women. Furthermore, although they form the bulk of the health workforce, women have long been underrepresented in leadership roles.
Women make up nearly 64 per cent of the health sector workforce in low- and middle-income countries and more than 75 per cent in high-income countries. On average, these women earn 20 per cent less than their male counterparts.
Part of the reason for the inequity in pay is that many women, about 6 million worldwide, serve in unpaid and underpaid roles in the health sector. These roles are typically those of community health workers.
Furthermore, many women health care workers face threats to their security, which includes gender-based violence, verbal abuse and discrimination. All these factors are contributing to global shortages in the health care workforce, with governments struggling to maintain the resources required to provide health care to the children that need them most.
Meet some of the women health care workers on the frontline, focused on eradicating polio in Afghanistan, Nigeria and Pakistan.
These are the steps we need to take to empower community health workers and set them up for success
It’s imperative that community health workers are provided with good and regular pay, and decent working conditions. That’s the minimum needed to recognize their dedication and invaluable contributions. Some of the other steps that need to be taken to ensure that community health workers are equipped to deliver to their full potential include:
- Changing compensation structures, focusing on less short-term contracting and intermittent funding for community health workers, instead increasing opportunities for full-time recognized employment.
- Ensuring that women health workers are better represented in leadership roles, offering them access to professional training and career advancement.
- Protecting health workers from discrimination and gender-based violence in the workplace, making sure they feel safe when they’re doing their job.
- Providing flexible working arrangements to help health workers better manage their family and professional commitments.
At a time when many children aren’t getting the vaccinations they desperately need, we need to take these steps to better support community health workers. That in turn can sustain and boost vaccination rates, particularly in historically underserved communities. That’s something that’s been happening in Nicaragua, thanks to an inspiring team of community health workers.
In Nicaragua, community nurses are reaching indigenous children in their homes
On an October morning, three community nurses dressed in white uniforms walked among the traditional tambo wood homes in the indigenous Miskito community of Sisin.
One carried a high-tech thermos for vaccines, another a scale, and the third a bag of vitamins and medicine.
As they climbed the staircase to Florencia Mena’s home, the nurses greeted Mena and her 3-year-old daughter, Rihana, in the Miskito language.
UNICEF/UN0719302/Oswaldo Rivas AFP-Services/Factstory
UNICEF/UN0719300/Oswaldo Rivas AFP-Services/Factstory
“The doctor and the nurses have seen me every month to keep a close eye on my daughter’s development,” Mena said. “She received the first vaccine at birth, and although at that time I was afraid that my daughter would get pain and fever, today I see her healthy and full of life.”
These nurses are making sure that Mena is on top of Rihana’s vaccination schedule.
In a remote and poor community, where houses built on pillars protect people from an often punishing climate, the visiting nurses are a vital link between an indigenous community and immunization.
“Children are given routine vaccines according to their schedule, their height and weight. Heights are taken, deworming and vitamins are administered if appropriate. If anyone else in the family has health problems, we also take care of that other person.”
As active members of the community, the nurses are a critical link between national primary health care services and populations that traditionally have been hard to reach. They’ve gained the trust of the communities they serve. Their success can be measured in the region’s vaccination, which stayed at 98 per cent in 2020 despite the COVID-19 pandemic and two disastrous hurricanes.
It’s crucial that we empower community health workers to succeed and thrive in their work
As we’ve learned during the COVID-19 pandemic, resilient community health systems are able to effectively respond to outbreaks, epidemics or pandemics, while continuing to provide essential services, including routine immunization.
Every community has a right to quality primary health care. Building the systems required to deliver quality care is paramount, and dependent upon community health workers who are the heartbeat of health care.
Success in this field will require immunization and health-care initiatives driven by local knowledge and expertise. Most importantly, it will demand a workforce – led by community health workers – who are paid, professional and prepared to reach children in hard-to-reach communities.
To vaccinate every child and provide them with the health services they need to grow up healthy and thrive, it is vital that we strengthen primary health care and provide its mostly female frontline workers with the resources and support they need and deserve to do their job to the fullest of their abilities.
