The Role of Global Health Actors in Supporting Sustainable CHW Financing
Community Health Workers (CHWs) are the backbone of primary health care systems worldwide. Yet, financing their work sustainably remains one of the greatest challenges for governments and partners. In partnership with Community Partners International ‘The Role of Global Health Actors in Supporting Sustainable CHW Financing’ Webinar brought together donors, governments, community voices, and technical experts from Sierra Leone, Guinea-Bissau, India, Indonesia, and beyond to surface insights, share emerging models, and collectively reimagine how global support for CHWs can shift from fragmented aid to long-term, catalytic investment that supports country-owned CHW systems.
These are 5 key takeaways:
1. Lessons from Sierra Leone: Domestic budget lines and investment cases are essential
Advocacy tools can empower ministries to champion CHW financing reform and sustainability.
Dr. Elizabeth Musa, a fellow at the Health Systems and Financing Fellowship Program (HSFA) hosted by Financing Alliance for Health (FAH), highlighted the critical role of CHWs in Sierra Leone’s health system. With 8,000 integrated CHWs earning between $15–$30 monthly, the country faces a heavy reliance on external donor funding.
“There is a momentum to establish a dedicated budget line for CHWs and there are also opportunities for joint financing models” Said Dr. Elizabeth. “Our minister is currently waiting for us to develop a return on investment and an advocacy deck which he is going to start using to advocate at all levels for domestic financing.” She added.
2. Lessons from Guinea-Bissau: Policy Implementation and accountability are key.
Laws must translate into actual budget allocations, and national strategies should be co-created with partners
Policy commitments must be backed with actual resource flows and effective implementation. Andrea Speranza Community Health Specialist, United Nations Development Program (UNDP), Guinea Bissau emphasized that policy alone isn’t enough, it must be effectively operationalized. Despite a law in Guinea-Bissau directing 40% of import taxes on alcohol, tobacco, and sugary drinks to health, funds are yet to be allocated. The country currently spends only 6–7% of its general state budget on health, far below the Abuja declaration 15% target.
“We are going to elaborate the new community health national strategy for the next four years… This will be an opportunity for the government and partners to open a national dialogue to brainstorm about all these challenges and the possible solutions.” He said.
3. The regional Perspective: Resource mapping must be embedded in national health planning to Close Gaps
Innovative financing mechanisms like Public Financial Management (PFM) reforms, can unlock domestic funding
Yan Tabsoba from AFF (African Frontline First) stressed the importance of resource mapping and gap analysis. Without visibility into CHW funding gaps, governments struggle to allocate resources effectively. “We support countries to institutionalize resource mapping in community health and integrate it into health sector resource processes. It’s translated into costed national community health strategies.” he stated.
Yan emphasized that resource mapping, gap analysis, and costed national strategies are crucial to help governments reallocate resources and improve budget execution.
4.Lessons from India: Incentivizing CHWs Beyond Salaries
Incentives beyond salaries like pensions, insurance, and recognition boost retention and morale, contributing to long-term sustainability.
Non-salary incentives and social protection mechanisms increase retention and sustainability. Grace Achungura – MBChB, MPH, PhD Regional Advisor, World Health Organization shared how ASHAs (Accredited Social Health Activists) in India are supported through a range of long term non-salary incentives and social protection schemes.
“Every ASHA that completes 10 years is given almost $600 and a citation… There’s a pension scheme, health insurance, accidental death, disability insurance scheme, and direct benefit transfers to their accounts, in recognition of their work.” Said Dr. Grace. With over one million ASHA workers serving across the country, these community health workers provide essential healthcare services such as maternal care, child immunization, family planning guidance, and disease prevention. Their contributions have been instrumental in reducing infant mortality rates (IMR) and maternal mortality rates (MMR) in India.
5.Lessons from Indonesia: Local Ownership Drives Sustainability
Decentralized governance can foster stronger community ownership and more sustainable financing models.
Unlike most countries, Indonesia places community health under village government structures, not just the Ministry of Health, effectively decentralizing governance to the community level. “This kind of local ownership is what makes funding really sustainable.” Resi, a Community Health Worker in North Lombok, Indonesia said. In 2014, new legislation directing central government funds to village governments was implemented. Today, more than USD $5 billion annually is deployed, directly impacting residents of more than 75,000 villages across the country. Indonesia serves as a clear example on how putting communities at the center of governance creates ownership and long-term financing pathways.
In conclusion, sustainable financing for CHWs is not just a technical challenge, it’s a political and strategic imperative. All actors must show up and collectively innovate to adequately finance country owned, country-led systems, and ensure CHWs are well supported, empowered, and retained.
ABOUT THE WEBINAR
Speakers
- Dr. Elizabeth Magdaline Musa is a public health professional with extensive experience in community health systems and Primary Health Care. She currently serves as the National Coordinator for the Community Health Worker Program under the Directorate of Primary Health Care at the Ministry of Health, Sierra Leone. In this role, she provides strategic
leadership, overseeing program design, coordination, training, advocacy, and supervision to strengthen community-based health service delivery.
- Dr. Grace Achungura is a Health Economist and medical doctor with 19 years of experience in the health sector across Africa, India, and Australia. She currently leads the WHO Country Office of India’s support for health system strengthening for UHC. Her work spans various domains including universal health coverage (UHC), health financing, health systems policy and planning, priority setting, resource allocation, and monitoring and evaluation of healthcare programs. She also brings clinical experience from her time as a medical practitioner in Uganda. Dr. Achungura has led and contributed to policy support initiatives focused on planning, implementation, and monitoring of health reforms, with a strong emphasis on sustainable health financing. Her leadership in high-level advocacy and strategic partnerships has fostered impactful collaborations and investments in health, benefiting both national and international stakeholders.
- Andrea Speranza, graduated in Political Science in 2000. Andrea began his career as a humanitarian worker, working with several NGOs in Kosovo, DRC, Albania, Gabon, Yemen, Rwanda, Senegal, Kenya, and Guinea-Bissau until 2018 in roles such as project management, country finance manager, and country director. He served as a World Bank health consultant from 2018 to 2023, providing technical support to the health sector Project Implementation Unit (PIU) in Guinea-Bissau. He served as a consultant to the European Union Delegation in Guinea-Bissau in the framework of a maternal and child health program from 2023 to August 2024. He has been employed by UNDP Guinea-Bissau since September 2024 as a health systems strengthening and community health specialist and is a father of two girls and a boy.
- Yann Tapsoba is a health economist, working as Health Financing Specialist for Financing Alliance (FAH) for Health and also servs as an expert in health workforce issues and public financial management (PFM). Through African Frontline First Initiative (AFF), he supports countries in strengthening community health systems, developing evidence-based strategies for sustainable financing and better coordination of CHWs programs.
- Resi Budiana is a dedicated women’s advocate from Senaru Village, North Lombok, has served as a Community Health Worker since 2011. In 2022, the Ministry of Health named her one of Indonesia’s top CHWs for championing health workers’ rights. Beyond her work at the posyandu, Resi promotes women’s involvement in village planning and teaches practical skills like home gardening to boost nutrition and income. Her efforts have empowered women to play a more active role in their households and communities. Resi’s grassroots advocacy continues through media and village forums, where she pushes for health equity and women’s empowerment.
- Maya Hayakawa, Communication Lead of Financing Alliance for Health, Moderated the session.
- Siyapah Surathumrong, Sr. CHW Symposium Manager of Community Partners International, gave a welcoming remark and introduced the webinar series.
Background
Community Health Workers (CHWs) have long been the foundation of effective, people-centered primary health care (PHC), delivering essential services where health systems are weakest. From maternal and child health to pandemic response and disease surveillance, their contribution is indispensable. Yet, despite global consensus on their value, CHW programs remain among the most underfunded elements of the health system.
While global health actors and institutions have made strong commitments (through declarations, resolutions, and funding pledges) the financing architecture for CHWs remains fragmented, short-term, and often misaligned with country priorities. Many programs still rely on siloed, vertical streams that undermine long-term sustainability and integration into PHC. This moment demands a deeper, collective reflection:
- How are global actors showing up for CHWs in practice?
- What does leadership look like in financing community health sustainably?
- What kind of financing architecture is needed to enable resilient, country-owned CHW systems as part of broader PHC reforms?
Resources and Materials
Further information
This webinar was especially co-organized by Financing Alliance for Health. This is part of a global series hosted by Community Partners International, in collaboration with ReBUILD for Resilience, SingHealth Duke-NUS Global Health Institute, and Community Health Impact Coalition, in the lead-up to the 4th International Community Health Workers Symposium, which will take place virtually on 10-14 November 2025. Please visit their websites to learn more about their work and contributions on CHWs and Global Health.
One Response
At the heart of all this is a bigger truth, we want our CHWs salaried, skilled, supervised and supplied. Financing CHWs is as much political as it is technical. Countries that figure out how to combine political leadership, smart financing, and real community ownership will be the ones that succeed in building truly resilient health systems.