Professionalisation of Community Health Workers: Time for a Formal Contract

Community health workers (CHWs) are the backbone of strong primary healthcare systems. If properly supported, they can add significant value to access to healthcare service delivery. Yet, despite their proven effectiveness globally, systemwide support for CHWs remains sub-optimal. This study explores the concept of ‘proCHW’ programs - where CHWs are skilled, supplied, supervised and salaried. We suggest a fifth component is added to this framework—security (defined as formal contracts). Currently, many CHWs work voluntarily without any formal contract, rendering them vulnerable to sudden replacements. Therefore, institutionalising formal contracts will provide legal safeguards for CHWs, ensuring fair and safe employment conditions, including a minimum wage and opportunities for career advancement. To enable funding for establishing formal contracts for CHWs, strong political commitment, public-private partnerships, and tailored funding strategies based on local administrative systems are needed. By addressing these challenges, sustainable funding can be achieved, maximising the impact of CHW-led programs and improving primary health care globally.