Submission ID 131366
| Issue/Objective | Community health workers (CHWs) occupy a paradoxical position in global health: recognised as indispensable to MNCH equity, yet consistently deployed within programme architectures that limit their agency, disconnect them from data systems, and fail to integrate them into accountable health system structures. The Challenge Initiative's MNCH scoping studies across Nigeria, India, Kenya, and Côte d'Ivoire document a different model - one in which CHWs (including ASHAs, ANMs, Community Health Promoters, and Mama2Mama peer networks) are embedded within community health systems rather than deployed as vertical project staff, with implications for both effectiveness and sustainability. |
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| Methodology/Approach | This paper presents a cross-country comparative analysis of CHW integration models documented in TCI's 2025 MNCH scoping studies, examining the organisational structures, accountability mechanisms, data linkages, and community trust dynamics that differentiated high-performing from under-performing CHW platforms. |
| Results | In India, Mahila Arogya Samiti (MAS) groups and Urban Health and Sanitation Days (UHSNDs) provided a community governance structure that extended CHP reach and enabled pregnancy tracking and postpartum follow-up independent of facility-based systems. In Nigeria, Mama2Mama peer networks improved referral completion rates and early ANC registration in communities with high male gatekeeping. In Côte d'Ivoire, Traditional Birth Attendant (TBA) integration into formal health structures - despite government resistance - expanded safe delivery referrals in hard-to-reach communities. Across all settings, CHW effectiveness was strongly predicted by the quality of feedback loops connecting community-level activity to facility-based coaching and government review mechanisms. |
| Discussion/Conclusion | CHW effectiveness is a function of system design, not individual capacity. TCI's multi-country evidence demonstrates that investing in the architecture of community health systems - including data integration, feedback loops, peer governance structures, and formal health system linkage - produces more durable MNCH gains than training-focused CHW deployment models. This finding has significant implications for how global health programmes design, finance, and evaluate community-level MNCH interventions. |
| Presenters and Affiliations | Victor Igharo Johns Hopkins University, W.H Gates Institute for Population and Reproductive Health Aaliya Habib Greenstar Social Marketing, Pakistan Adewale Adefila The Challenge Initiative |
