Reinforcing community health workers program in africa for universal health coverage and global health security: A call for concerted efforts

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A vibrant primary healthcare system is essential to ensure the attainment of Universal Health Coverage (UHC) and the global health security (GHS) agenda.Community health workers (CHWs) are critical elements of a functional primary healthcare system that bridge the community and the healthcare system itself [1,2].CHWs are the lowest level of health cadres, mostly women (70%), who are trusted members chosen by the local community members or organizations to provide basic health awareness and services within their community [3,4].CHWs often understand their community better as they are often recruited from the community, enabling them to serve as a bridge between health services and the community.The CHWs might be known as health extension workers, village health workers, community health agents, and community health promoters in different countries [4,5].Community health workers' contributions to disease prevention, control, and health promotion have been demonstrated in peaceful times and during public health emergencies such as the COVID-19 pandemic, Ebola outbreak, and HIV epidemic control.During these crises, CHWs played pivotal roles in community education, contact tracing, vaccine distribution, and providing essential health services to underserved populations [6].Their deep connections within communities enabled them to build trust, disseminate accurate health information, and address misconceptions.Furthermore, CHWs helped to maintain continuity of care by facilitating access to medical services and supporting patients in adhering to treatment regimens [7].Their efforts not only helped to curb the spread of diseases but also mitigated the impact of the pandemics on healthcare systems, highlighting their critical role in strengthening public health infrastructure and resilience.As demonstrated by the Ethiopian health extension program, the CHWs have substantially contributed to the strengthening of health systems, thereby contributing to meeting health-related targets of the Millennium Development Goals by 2015 and progressing to meeting the Sustainable Development Goals by 2030 [5].A systematic review by Blanchard et al. reported that CHW interventions can address inequity gaps in maternal and newborn healthcare [8].A study in Liberia also indicated that the percentage of malaria diagnoses confirmed by microscopy or rapid diagnostic tests increased from 71% to 95% attributed to the CHW program [9].However, multi-faceted programmatic and operational challenges such as poor structural and functional governance of CHW's program, siloed and fragmented coordination

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