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How can we build sustainable large-scale national CHW programs?
Henry Perry, MD, PhD, MPH Senior Scientist
Johns Hopkins Bloomberg School of Public Health
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
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
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”)
Hospital-centrism: health systems built around hospitals and specialists
Source: MOH, Republic of Ghana, A Primary Health Care Strategy for Ghana, 1978
Available at: http://www.mchip.net/sites/default/files/MCHIP_CHW%20Ref%20Guide.pdf
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)
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
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
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)