Community health workers form an essential frontline force
Koko Patience Samuel remembers how it felt to save a new mother’s life.
On that day in 2023, she arrived for her shift at a rural health clinic in Nigeria to find a patient hemorrhaging after giving birth. Samuel immediately used an antishock garment that applies pressure to slow the bleeding. Then she quickly reviewed her options.
“We were able to refer some cases to higher-level facilities. So we rushed her to the health center,” she says. “We got her out of [danger], and she was fine. It was amazing.”
Samuel is a community health worker trained in maternal and child health care through Together for Healthy Families in Nigeria, a Rotary Programs of Scale grant recipient. She’s also part of a vast, but sometimes overlooked, workforce in public health. Around the world, millions of community health workers provide essential frontline care in low- and middle-income countries. They’re not medical professionals, but they can perform basic health interventions and advise people on topics including maternal and child health, nutrition, vaccination, and family planning.
Community health workers perform outreach for the Together for Healthy Families in Nigeria program.
Image credit: Maryam Turaki
They support everything from routine care in their home communities to large-scale campaigns by major global health and aid organizations, often traveling long distances to reach unserved people in rural areas. With a projected global shortfall of 11 million health care providers by 2030, community health workers are expected to increasingly fill gaps.
“Their responsibilities are ballooning because people realize how great they are,” says Svea Closser, a professor at Johns Hopkins University in Baltimore, who has studied community health worker programs in numerous countries, including Ethiopia, India, and Pakistan. “But sometimes the remuneration and support have not kept pace with the expanding responsibilities.”
With the growing reliance, the World Health Organization and others are calling for fair pay and for better training and support for the world’s estimated 4.7 million community health workers, around two-thirds of whom are women.
Some of the largest community health worker programs, including initiatives in Pakistan, India, and Ethiopia, only employ women. “A lot of countries prefer women, partially for really good reasons, like they are better suited to address maternal and child health. They’re just socially better positioned to do it,” says Closser. “But there are also, potentially, some more problematic reasons, like you can get women to work for less pay.”
Linet Otieno, who teaches sex education in Siaya County, Kenya, has volunteered without pay for around seven years, she says, because the work is rewarding in other ways. She does work for both the Kenyan Ministry of Health and a nonprofit, the ABCs of Sex Education, which received funding from a Rotary Foundation global grant in 2020.
Left: Linet Otieno receives a certificate for her work in sex education. Courtesy of Kathy Tate-Bradish. Right: Koko Patience Samuel, who is trained in maternal and child health, says the job “gives me joy.” Courtesy of Ashezi David.
“I love my job. I love serving the community because I get to interact with so many people,” Otieno says. “People appreciate the services that we offer to them. When you see somebody in the community that you’ve assisted in some way, you just feel motivated, because you get that recognition.”
Still, Otieno sometimes encounters situations that are far more complex than she’s been trained to handle — such as when she learns that a child is being physically or sexually abused. “We always report to the [community] chiefs. And at times we’ll get the families called in for a talk,” she says, while noting there’s little more she can do. “It’s never easy.”
Community health workers also experience abuse and violence themselves. A study Closser co-authored in 2023 found that female community health workers around the world were frequent targets both within their programs and in their communities. “These workers are really at the bottom of the health care hierarchy,” says Roosa Tikkanen, another co-author of the study. “Sometimes the perpetrators are actually their supervisors. So who do you even report to?”
In 2018, the World Health Organization released its first-ever guidelines for community health worker programs, including a recommendation for fair pay. Since then, researchers and advocacy groups have called for workers to receive contracts, more extensive training, better oversight, and better pay — or any pay. Following through on those recommendations has the potential to make the sector a driver of economic growth by creating good jobs, particularly for women, while also ensuring more people have access to health care.
In many parts of the world, community health workers provide the only care that people receive. And their contributions are far-reaching. Community health workers have participated in efforts that have reduced AIDS-related deaths by nearly 70 percent since 2004. These workers also treat more than half of malaria cases in some parts of the world, including 10 districts in Zambia where Partners for a Malaria-Free Zambia, another Rotary Programs of Scale grant recipient, trained and equipped 2,500 community health workers.
Community health workers gather for a meeting in Karachi, Pakistan, in 2022. Pakistan employs nearly 450,000 community health workers in its efforts to eradicate polio in the country. Image credit: Khaula Jamil.
While that program relies on volunteers, other Rotary-supported initiatives do pay community health workers. A 2020-22 Rotary grant-funded program in South Africa, in partnership with the University of Pretoria, paid slightly more than the South African minimum wage at that time of around $1.50 per hour.
Pakistan, one of the two countries where the wild poliovirus remains endemic, employs nearly 450,000 community health workers in its efforts to eradicate the disease. As trusted community members, they play a key role in administering vaccines and spreading word to family and friends that vaccination is safe.
By the numbers
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7 out of 10
Jobs in the health and social care sectors worldwide that are held by women
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4.7 million
Estimated number of community health workers
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13%
Projected 10-year growth of community health worker jobs in the U.S.
“It is very important for people to have social and emotional attachments to the workers who end up at their doorsteps. It’s like, ‘The people from within us would never harm us,’” says Israr Ul Haq, a social and behavioral change specialist for UNICEF who helps oversee Pakistan’s community health worker program. “That social buy-in is very important. After many years of this program, more than 95 percent of people open their doors to get their children vaccinated.”
In other countries, too, the trust that the workers establish in their communities, often by going door to door, is making a difference, including by connecting families to services. “It’s different from house to house,” says Rebaone Madzivhandila, a research assistant at the University of Pretoria, who oversaw community health workers as part of the Rotary-supported South African project. “It depends on what challenge a particular household is facing. If it’s malnutrition or food insecurity, then the community health worker will bring in dietitian to assist. If a household is facing social issues, then they will bring in a social worker.”
That kind of work is not limited to developing countries. In the United States, for instance, about 63,000 community health workers connect people with local health resources, counsel people who have been discharged from hospitals, and educate communities about chronic conditions such as diabetes and asthma.
In Nigeria, Samuel is paid a $10 monthly stipend, but she is also driven by the importance of the work and the results she can see, as when her community shed some of its cultural resistance to talking about subjects like birth control. “When the program started, we had family members who didn’t want us to come in and speak about family planning to their wives and daughters,” she says. “But with the advocacy we had from the state midwife, everything was sorted out. She came and organized community meetings and made them understand the need for child spacing and other activities.”
Samuel, who has been doing the job for four years, particularly appreciates the opportunity to teach her community about good health practices. “I love the fact that I’m able to educate people, to reach out to them,” she says. “And their feedback is positive, so it gives me joy. I’m providing knowledge they need to know.”
This story originally appeared in the August 2025 issue of Rotary magazine.