Since the Millennium Development Goals (MDGs) were implemented in 2000, community health workers (CHWs) “have … been part of an international attempt to revise primary health care delivery in low-income settings, and CHW programs have been changed accordingly,” Prabhjot Singh, co-chair of the One Million Community Health Worker campaign, and Jeffrey Sachs, director of the Millennium Villages Project, write in a Lancet opinion piece. “Instead of being regarded as unpaid, lightly trained members of the community who focus mainly on health education and provide basic treatments, CHWs are increasingly envisioned as a trained and paid corps who give advice and treatments, and implement preventive measures,” they note. The authors discuss the results of a June 2011 Technical Taskforce convened by the Earth Institute at Columbia University “to examine the best practices for scaling up and integrating CHWs into health systems.” Singh and Sachs note “[t]he Taskforce agreed that to achieve the MDGs, roughly one million CHWs should be trained and deployed in sub-Saharan Africa by 2015.”

“To support the achievable goal of one million CHWs across sub-Saharan Africa by 2015, additional financing will have to be mobilized to support well-tailored, country-specific plans,” Singh and Sachs write, adding, “We regard the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Global Alliance for Vaccines and Immunizations (GAVI), and the World Bank as the three most relevant potential partners in such initiatives.” They continue, “The case for an expanded and dynamic CHW subsystem is very strong. CHW subsystems are proven, effective, low cost, and rapidly scalable components of rural health care systems,” and conclude, “CHW scale-up in low-income countries, particularly sub-Saharan Africa, will be a crucial stepping stone towards achievement of the MDGs and the overarching aim of health for all” (7/27).