By the Africa Frontline First Team
Speaking in Soli, her native language, Maelesi Nyangu repeatedly used one English word to describe her prenatal care: encouragement. This is thanks to Barbara Mdunulu, the community health worker assigned to her community. As part of her job, Barbara encourages Maelesi to attend her pre-natal visits at the local clinic and monitors her overall wellbeing. Barbara encourages Maelesi to sleep under a mosquito net at night to ensure she doesn’t contract malaria again. Barbara also provides Maelesi with trusted advice and companionship as she prepares for her third child. This pregnancy feels different, Maelesi told us. She feels stronger, calmer, and more confident. That’s because Barbara has been walking alongside her every step of the way.
Barbara is one of thousands of community health workers across Zambia who are making sure that no one in their community falls through the cracks. Her work, and the work of Zambia’s other 6,000 recently trained community health workers, is supported in part by the Africa Frontline First Catalytic Fund, a $100M partnership between Africa Frontline First, the Global Fund, the Johnson & Johnson Foundation, and the Skoll Foundation that invests in the foundational elements required to improve the quality and sustainability of national community health programs. Working closely with the Africa Centres for Disease Control and Prevention, the Catalytic Fund is part of continental mandate to strengthen the community health workforce. In Zambia, the Catalytic Fund provides financial support to advance the Ministry’s top priorities for community health, including: more robust training on integrated services, digital data collection, a national registry of community health workers, and accountability measures.
In Zambia, community health workers currently provide an array of different services, often verticalized or disease-specific. While community health workers may be experts in treating a specific disease, this model fragments care and divides resources that could be better spent training community health workers on a comprehensive set of integrated health services – aligning with the interconnected nature of health and disease. In one household, there may be a pregnant woman in need of antenatal counseling, a grandfather with tuberculosis symptoms, and a child with a fever. Rather than three specialized workers, one community health worker trained across a set of primary health care services could address the needs of the entire household. Recognizing the need for change, the Ministry of Health is rolling out polyvalent training (covering multiple disease and health priorities) for existing and new community health workers to build a strong workforce capable of holistically addressing disease and mortality across Zambia. Polyvalent training is being rolled out alongside other quality improvement training like digital data collection.
Since finishing her most recent training with the Ministry of Health, Barbara has been providing outreach and care to Maelesi and her family, and 136 other families in her catchment area. Barbara is part of a cohort that has recently been trained on Community Health Information Platform (CHIPs), Zambia’s digital health system that tracks all household and health data collected by community health workers. While Barbara has been working in different capacities as a community health worker since 2017, her work feels different now—her formalized training, recognition, and tools have empowered her and freed her time to take better care of her community.
Before being trained on digital data collection, Barbara would have tracked her visits with Maelesi on paper records. These sheets were cumbersome and could be easily lost or damaged. Heavy rains and floods could wipe out years worth of records in the course of a day. While it’s only been a few months since Barbara made the switch to digital data collection, she’s already seeing the transformative impact it has had on her workload. Barbara spoke enthusiastically about the ease of digital collection and the confidence she feels knowing her patients’ data is safely stored.
CHIPs, currently piloted in 53 communities in Zambia, is changing the way healthcare is delivered at the community level. CHIPs simultaneously improves data quality and community health worker performance. CHIPs ensures that all data is reported up the chain of command from community to national level and allows for better insight into health outcomes and community health worker performance. Additionally, built-in prompts and reminders support community health workers with real time diagnosis and follow-up. For example, all of Maelesi’s appointments at the clinic are synced into her profile on Barbara’s smartphone and she receives prompts when it is time to visit Maelesi.
Digital data collection is just one of the many ways that Zambia is strengthening the quality of its community health program. In the past year, the Ministry has revised critical policy and training curriculums and processes of the national program to make deverticalization possible. The Ministry has also developed and launched a national geo-referenced master list. Before the master list, the Ministry was trying to run a team of community health workers without knowing who was on it or where they were. Now, thanks to the master list, the Ministry knows exactly where each community health worker is working – and can make sure they are backed with the training, tools, and resources they need. It’s these policies that enable Barbara and thousands of other community health workers like her to not only do their jobs, but do them at quality and with dignity. Investments in foundational elements lay the groundwork for fair and regular payment, effective training, and adequate access to supplies, necessary precursors to empower community health workers to perform their jobs well.
These changes in Zambia are part of a broader change—one that prioritizes coordinated, government-led investments in community health. With support from the Africa Frontline First Catalytic Fund, eight countries including Zambia’s Ministry of Health have been working to modernize and strengthen its community health workforce. Much like Zambia, countries have been making progress in critical areas—like budgeting, digital health, blended learning, and community health worker mapping.
The Catalytic Fund backed by investments from public, private, and social sectors, enables governments to set their own priorities—rather than bending to fragmented, short-term donor agendas—and invests in the foundational systems that make universal health coverage possible. Dr. Kalawanga Kalawanga, the Assistant Director in Health Promotion and Community Health for Zambia, spoke strongly of his support for the program, stating “we appreciate the Africa Frontline First Catalytic Fund because it supports our existing priorities at the Ministry. Together, we’re strengthening the national program to be able to provide higher quality care to more Zambians than ever before.”
Zambia’s progress is a powerful reminder of what’s possible when governments lead with a bold vision and partners align behind a common goal. At Africa Frontline First, we believe this is the path forward: integrated community health programs, coordinated financing, and support for country-led agendas. Lasting change requires investments across different levels of the system—from Barbara providing care in her community to the policy that ensures she’ll be compensated for the care she provides. As the world reels from shifting dynamics, we’d like to echo Maelesi, and offer a bit of encouragement ourselves.
Let’s encourage more governments to lead.
Let’s encourage more partners to coordinate.
Let’s encourage more investment in the people and systems that make health happen.