BIRCH in Senegal: Unlocking the True Potential of Community Health Through Smart Financing and Impact

Over the last decade, Senegal has shown that sustained investment in community health can deliver real measurable health gains. With a population of 19 million people, community health workers (CHWs) play an indispensable role in extending essential services to communities that would otherwise be left behind. Yet as health needs evolve and external financing becomes more constrained, the challenge is no longer only about securing resources, but more about ensuring those resources are well aligned, strategically deployed, and sustainable over time. 

Senegal made bold steps in its National Strategic Plan for Malaria Control  (2021–2025) that set ambitious targets to reduce malaria incidence and mortality by at least 75% and to interrupt local transmission in at least 80% of eligible districts by 2025.At the same time,  initiatives such as the Building Investment for Resilient Community Health (BIRCH) have been supporting countries  to strengthen community health systems in low-resource settings. Launched to bridge persistent gaps in community health financing and programming, BIRCH empowers Ministries of Health to secure sustainable funding, integrate CHWs into national strategies, and scale high-impact interventions with a strong focus on eliminating cases and deaths resulting from HIV, TB, and Malaria.  

Supported by the Financing Alliance for Health, Senegal leveraged a comprehensive analysis of its community health system to unlock €49.1 million through the Global Fund Grant Cycle 7 (GC7) and €20.1 million through the COVID19 Response Mechanism (C19RM)—critical investments for community health. This financing directly operationalized national priorities, strengthened integration across HIV, tuberculosis, malaria, and resilient and sustainable systems for health (RSSH), and helped ensure community health was treated as a core pillar of national health financing rather than a peripheral intervention. The results informed both implementation under the 2019–2024 National Community Health Strategy and the roadmap for the 2025–2029 strategy 

Senegal’s health financing context is a real life example of why this work matters. Health expenditure stands at approximately 4% of GDP, with per capita spending around USD 75. In such a constrained fiscal environment, every investment decision must be grounded in clear priorities and strong evidence. 

This work builds on a strong track record of community health impact in Senegal. These investments have contributed to significant improvements in malaria outcomes, with cases declining by 64.3% in 5 years (2018-2023) and reported deaths by 29.9% between 2017 and 2023. Community health workers manage an estimated 17–26% of malaria cases annually, delivering diagnostics, treatment, and prevention services at the frontline. More recent routine data indicates that under five cases represent only 10% of total malaria cases, highlighting significant progress. Senegal has also maintained a relatively low HIV prevalence of 0.3%, while TB incidence has declined to 131 cases per 100,000 people. 

It hasn’t all been roses and peaches. The road ahead still demands sustained investment, tough choices, and longterm commitment—especially as health spending remains below global targets and pressures continue to mount. Persistent challenges remain—from sustainably compensating community health workers to addressing maternal mortality, child health, and the rising tide of noncommunicable diseases—but the signal is clear amid the noise reinforcing a simple but powerful truth: when community health is strategically planned, adequately financed, and fully integrated into national systems, it delivers results that endures. 

Senegal’s priority now is ensuring that both new and existing resources are deployed efficiently, equitably, and in ways that reinforce the system as a whole. By linking evidence to financing decisions and aligning investments with national priorities, the country is on a promising path to sustain progress and remain agile in the face of future shocks. Most importantly, this moment has reaffirmed the central role of community health workers—not as a stopgap measure, but as a foundational pillar of a resilient health system capable of delivering for all.