Remarks by Deputy Administrator Donald Steinberg at the U.S. Government Evidence Summit on Community and Formal Health System Support for Enhanced Community Health Worker Performance

Thursday, May 31, 2012

Good morning.  I’m pleased to be here today to kick off this evidence summit on community health workers and the role they play in improving health outcomes and saving lives. 

This summit is part of a broader series of roundtables on components of the President Obama’s Global Health Initiative, and it’s another important step in our efforts to put knowledge and learning at the center of our global development work. 

I‘ve had the pleasure to participate in previous summits on the role of trained practitioners in maternal-child health care and on efforts to assist children outside of family care. 

At USAID, we’re committed to bringing together practitioners, researchers, social scientists, advocates, private enterprise, foundations, international organizations, and government officials from donor and partner countries to address the world's most difficult development challenges.

And so I wanted to begin by thanking you both for the work you’ve already completed in reviewing the evidence and formulating the recommendations that serve as the basis for discussions over the next two days, and for your commitment going forward. 

In particular I want to thank Ambassador Jimmy Kolker from Health and Human Services, Mickey Chopra from UNICEF, Mubashar Sheikh from the Global Health Workforce Alliance, and David Oot from Save the Children, who will be presenting their perspectives and experience with community health worker programs this morning. 

I‘m also particularly grateful for the participation of representatives of seven ministries of health from Africa and Asia.  You bring experience, wisdom and ground truth to our work, which is essential as we review recommendations and develop an agenda for supporting these community workers and improving programs for the most hard-to-reach populations.

Health service delivery in countries with critical health worker shortages remains a major challenge facing the global health community and an obstacle to reaching the health-related Millennium Development Goals. 

I’ve spent most of my career in developing countries in Africa and Asia, where there is a lack of doctors, nurses, midwives and other professionals.  In these environments, community health workers are the key to better health at the local level.  They provide the life-saving information, medicines and referrals which can save a child from dying from malaria, diarrhea or pneumonia, or a mother or infant from dying in childbirth. 

I’ve recounted the story before, but this summit brings me back to where I started in the development arena.  Thirty-five years ago, I went out to my first Foreign Service assignment in the Central African Republic, where I was asked to help create and implement a $2 million health project for the rural province of Ouham.

With no experience, I had the novel idea to travel to the region and talk to the people there.  We first talked to the government officials – provincial governor and mayors.  Incidentally:  all men.  They told us that health conditions were generally acceptable, and that the principal need was an air conditioned office building for government workers.

Then we went out to the marketplace and the community centers to sit under baobabs trees and talk to women.  They said that the principal health problem was that mothers and children were dying in vast numbers from childbirth and preventable childhood diseases. 

They said that the causes included mothers in weakened conditions from malnutrition, malaria, diarrhea, and schistosomiasis; the absence of trained midwives and birth attendants; and the lack of clinics at the village level with most basic drugs.  They were also realistic enough to know that neither their government nor the donor community would build them a big fancy hospital filled with doctors and nurses. 

And so we took their cue.  We put together emergency feeding programs for children and pregnant and lactating women.   We supported training and financial incentives for community health workers.  We built and stocked village health huts.  Over the next two years, we monitored the progress, made course corrections, and built local capacity to take over the program.  Two years later, we could already see significant declines in child and maternal mortality.

As I reflect back, our conversations with those women in the marketplace was an early form of an evidence summit.  The methods we applied in the Central African Republic are being mirrored throughout the world, and we’re having real success and getting new attention.  Read the Washington Post editorial this morning, entitled:  “The Drop in Child Mortality:  A Wonderful Accomplishment Offers Promise for the Future.” 

The editorial notes that two weeks from today, USAID, in collaboration with UNICEF and the Governments of India and Ethiopia, will be hosting a Call to Action to End Preventable Child Deaths here in Washington.  Community health workers are central to achieving the vision of ending preventable child deaths.  Without their efforts to reach the most remote communities where there is no other access to health services, this vision cannot be achieved. 

Our government has a long history of improving the supply and quality of human resources for health. For decades, USAID and our US government partners at State and HHS have integrated education, training and support of health workers into our programs.  These investments have accelerated since the fight against HIV/AIDS and the advent of PEPFAR, under which we have trained almost 300,000 of these workers in the last two years alone. 

But training alone won’t ensure the effective and sustainable improvements, even at the community level where providers are closest to those they serve.  And so our approach to human resource strengthening thus includes efforts to also improve the motivation, productivity and retention of health providers. 

For this reason, this summit is focused on community health worker performance.  We know what community health workers are able to achieve and the impact they can have on the health of their communities, but we know less about how they work or the interaction of the systems within which they function.

The CHW is a key actor at the intersection of two dynamic and overlapping systems.  Both the community and the formal health system provide support to these workers.  How this support is provided is not often examined and how these two systems interact to influence CHW performance is rarely considered.

By being evidence-based, we help to ensure that we can save the greatest number of lives as cost-efficiently as possible and that our investments will be sustainable by our partner countries.

In this time of diminishing donor resources, and in accord with the principles of President Obama’s Global Health Initiative, we are supporting   “country ownership” and investing in country-led plans.

Throughout this summit, and especially tomorrow, we will be looking to the representatives of partner country governments to provide your perspectives on how we can work together to achieve greater sustainability and strengthen country stewardship of community health worker programs.

We also need to consider how to build innovative and sustainable coalitions among donors, partner governments, civil society, and the private sector, recognizing that no single entity has the capacity to do this alone and recognizing that no one has a monopoly on financial resources, on good ideas, on ground truth or on moral authority. 

In conclusion, I want to urge you, throughout the next two days, to keep your eyes squarely focused on the prize:  the fight to improve health outcomes and save lives in developing countries.  And in so doing, we will need to keep these people themselves at the center of our discussion.

Thinking back to the lesson of the Central African Republic, our strategies must involve them as planners, implementers and beneficiaries of all our programs.  We have an expression at AID:  “Nothing about them without them.”   Let that admonition guide our work over the next two days.  I wish you a productive two days, and I look forward to the outcome of your deliberations and follow up actions.  Thank you.

Kaiser Family Foundation Washington, DC

Last updated: September 26, 2017

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