Transforming Community Health for Children Worldwide
Summary
In 2023, UNICEF committed to building a global coalition that is accountable to provide aligned and coordinated support to nationally led country-level action for community health systems. This commitment supports the development of a robust, multidisciplinary, and multisectoral community health workforce that is trained and has the resources needed to provide essential, life-saving health services. In a select number of priority countries, UNICEF and partners will increase the number of women and children, including adolescent girls, with resilient access to essential services at the community level, including health, nutrition, WASH, and other context-specific interventions, with a focus on the youngest, the poorest, and most marginalized.
Approach
This commitment supports creating a robust, interdisciplinary community health workforce for essential health services. It aligns with the 2023 Monrovia Call to Action, promoting funding, expansion, and enhancement of community health programs, and the Community Health Roadmap Partnership strategy that aims to support at least 1 million CHWs—primarily women—to be paid and trained, impacting 66 million children and 100 million women yearly across various developmental and fragile environments.
UNICEF and its partners’ strategic approach aims to simultaneously accelerate progress on two interrelated fronts. At the global level, they will expand and operationalize the existing partnerships and build a global coalition that is accountable to provide aligned and coordinated support to nationally led country-level action for community health systems. At a country level, they will increase the number of women and children, including adolescent girls, with resilient access to essential services in their community, including health, nutrition, WASH, and other context-specific interventions, focusing on the youngest, the poorest, and most marginalized. Through this Commitment to Action, UNICEF will begin activities in 18 of the most affected countries.
Implementation of this program may present several challenges. Integrating CHWs into the broader healthcare system requires defining clear roles, ensuring resource access and support, and facilitating communication with healthcare professionals to maintain care consistency. In addition, adequate training and continuous education are essential for CHWs to ensure the program’s success. Lastly, funding is a significant hurdle, as CHW programs need financial support for wages, training, equipment, transportation, and other operational expenses. There is also the need for fair resource distribution, particularly in areas with numerous healthcare demands.
UNICEF’s broad experience in the implementation of these programs, alongside their long-standing collaborations with local and community-based partners, will allow UNICEF to address the above challenges and drive the success of this commitment.
Action Plan
Country-level implementation will be tailored to national plans and priorities.
The action plan will include steps to:
Q3 2023
Expand the coalition of global partnerships to deliver on community health. This will establish an operational partnership that will take action and will be accountable to support 25 countries with funding, technical assistance, and political support. This partnership will support national sectoral and multi-sectorial priorities, plans, and budgets, including those focused on community health systems. UNICEF will begin with the 10 most affected countries.
Q1 2024
Establish a transparent and agreed-upon country engagement process to streamline the support of regional and global level partners for priority countries. Regular reporting and monitoring processes established.
Q1 to Q4 2024
Conduct high-level political and technical missions with key global, regional, and national stakeholders to ensure engagement at the highest political level, engaging with Ministers of Health, Ministers of Finance, and heads of government to prioritize primary health at the community level.
2024 to 2026
Increase availability of essential commodities, ensuring qualified CHWs have life-saving commodities on hand.
Identify and overcome funding gaps that hinder the implementation of the national community health plans.
Strengthen accountability (data and monitoring) for community health systems.
Establish Communities of Practice for south-to-south learning.
Regular reporting on progress.
Background
Impressive progress has been made in reducing young child deaths over the last few decades. However, this progress is now under threat of stagnation and even reversal. Children’s health continues to be endangered by a myriad of factors impacting the poorest and most marginalized children. Poverty, climate change, malnutrition, and inaccessible or inadequate health, social care, and services are preventing millions of children from surviving and thriving. The global economic crisis has further deepened the deprivations facing these children. 14,000 children under the age of five are dying each day, 45 million children are suffering from wasting annually, and almost 800 maternal deaths occur every day, with 70% in Sub-Saharan Africa. (UNICEF, 2023) Despite some country-level progress and a growing momentum including the recent Monrovia Declaration, the community components of public health care programs face a number of roadblocks, in particular: 1) Insufficient and fragmented investments in community health systems are excessively reliant on external funding with limited domestic resources allocated to essential recurrent expenditures such as salaries and skilling of community workers and critical commodities, 2) Gender discriminative policies and practices impact financing for community health workers, who are primarily women, and 3) Community health initiatives are not properly integrated into the broader primary health care system.
Without urgent action to address these roadblocks, at least 30 million more women and children will die by 2030, more than half of them in sub-Saharan Africa. Millions more will fail to achieve their full potential and realize their rights.
Progress Update
Partnership Opportunities
In implementing this CTA, UNICEF is committed to engaging international and national stakeholders, including governments, civil society, and frontline organizations.
UNICEF is also seeking international and domestic investments for the financing of this commitment., Existing stakeholders include the African Union, African CDC, Gavi, the Vaccine Alliance, Global Financing Facility, Global Fund, USAID, USG President’s Malaria Initiative, World Bank, WHO, UNICEF, UNAIDS, Bill & Melinda Gates Foundation, and CORE Group. More partners at the global and regional level are anticipated to join.
For national governments, the initiative will provide access to advocacy resources, technical information, and support for conducting national assessments, setting national targets, adopting policies, laws, regulations, and standards, developing sectoral capacities, and involving and empowering local communities.