Inspiring communities in global health: Community Health Workers and Universal Health Coverage

Posted on 31 May 2017

We are delighted to announce details of an upcoming interdisciplinary workshop reflecting on the role of community health workers

Universal health coverage is one of the greatest unfulfilled ambitions in global health. Almost 40 years after the Alma Ata International Conference (1978), scholars and practitioners are still trying to understand the elusiveness of this goal. An upcoming workshop, to be held on 12 June 2017, will focuse on two interlinked features: the impetus towards the mobilization of communities in the definition of health policies and the delivery of care; and the role played by community health workers (CHWs) in this process. On the one hand, communities were heralded as the natural site for the mobilization of health initiatives aimed at the democratization of access – indeed, community responses were seen by many as a privileged strategy to avoid top-down, ‘one size fits all’ approaches. On the other hand, from the outset CHWs functioned as a rallying point for the improvement and democratisation of healthcare, with more equitable and affordable coverage being combined with the promotion of healthy lifestyles and environments. Since then, whilst lip-service continues to be paid to community-centred approaches, their fate has often been subject to the vagaries of donor agendas. Likewise, CHWs have fallen victim to cost-cutting and to a global shift towards the control and eradication of specific diseases.

Photo credit: Anja Ligtenberg, Direct Relief

Photo credit: Anja Ligtenberg, Direct Relief

The interdisciplinary workshop will explore the efforts to inspire and mobilize community participation throughout the twentieth and twenty-first centuries, and the role played by CHWs as a unique mechanism for the improvement of health systems with the potential for enhancing equity by bringing services to the previously excluded, while also enhancing democracy by mediating marginalised groups’ perspectives through to decision-making processes. The workshop will focus on a combination of historical analyses, contemporary perspectives and case-studies, centred around, but not limited to, the following questions: 

  1. What is the role of CHWs in the project of universal health coverage? Specifically, how do they contribute to delivering equity and democracy?
  2. How, when and why did different community health programmes emerge in different countries around the world? What challenges did they face and what was their legacy?
  3. What is the political context in which CHWs work and what constraints have they faced?
  4. How have CHWs interacted with other health workers, most notably nurses and midwives?
  5. What lessons can be learned from existing examples of CHW? What potential is there for advancing universal health coverage?
  6. What is the role of the WHO and its regional offices in promoting universal health coverage through community approaches?

The event will be live-Tweeted on the day. We will be sharing further details soon, including a list of participants - so please stay tuned. We will also produce a report of the workshop, to be disseminated widely.

This workshop is organized by Dr João Nunes (Department of Politics, University of York) and Dr Alexander Medcalf (WHO Collaborating Centre for Global Health Histories, University of York). The organizers gratefully acknowledge the support of the Department of History and the Department of Politics at the University of York, and the support of the Wellcome Trust.

This workshop is funded through a Wellcome Trust Seed Award for the project ‘Community health workers in Brazil and the global movement for universal health coverage’. You can access a report on the project findings so far via the University of York's Research Themes page.