One Million Community Health Workers

Twenty-four years ago, in 1989, leaders of the United Nations (UN) and the United Nations Development Programme (UNDP) named July 11th World Population Day. This annual event was designed to mobilize the international community around the challenges of rapid population growth. The event was originally inspired by the fearful realization that the human population was approaching 5 billion. Today, far from approaching a solution to the crisis, the world population has surpassed 7 billion with the most rapid increase in regions least equipped to: (1) face increasing demands for social, economic, and medical resources or (2) employ measures for birth control and family planning. The strategic deployment of community health workers (CHWs) in these regions can both satisfy the growing demand for healthcare and empower women with the resources to take ownership of their own fertility.

Demographic growth, healthcare, and development are deeply interconnected. The annual Failed State Index (FSI) shows a correlation between countries with rapid population growth and those with the lowest quality of life. Moreover, the population of the twenty lowest scoring  in the 2013 FSI is projected to reach 1.7 billion by 2050—the problem is only getting worse. It is a Catch-22: population growth makes improving access to healthcare difficult (especially in rural regions), yet access to healthcare is the prescription for uncontrolled population growth.

CHW programs—expanding primary healthcare networks and the delivery and administration of healthcare services—present a promising solution.  CHWs are critical because they can both expand healthcare coverage to vulnerable populations in growing rural regions and provide the world’s poorest women with resources to ensure safe and predictable childbirth.  The outcome is twofold: restraining the number of annual childbirths worldwide and drastically reducing the maternal mortality rate (MMR) in developing regions.  For perspective, in 2010 there were 500 deaths for every 100,000 live births in Sub-Saharan Africa. Many mothers also become injured, sometimes fatally, during unsafe abortions, the need for which could be eliminated by CHWs.

The focus of this year’s World Population Day is adolescent pregnancy. UN Secretary-General Ban Ki-Moon demands that “global attention” be focused on this issue. The World Health Organization (WHO) not only underscores the importance of reproductive health programs, but emphasizes the merits of CHWs as a family planning resource. According to the WHO and other leaders in family health, CHWs can provide: counseling on family planning and healthy pregnancy spacing; contraceptive methods (including condoms, pills, fertility awareness methods, and injectables); and  long-acting or permanent contraception This year’s focus on adolescent pregnancy highlights not only health issues, but also a systemic problem caused by limited family planning resources. When adolescents become mothers, their ability to expand their educational and economic opportunities is stagnated, further entrenching them and their communities in a poverty trap.

Population growth in developing regions is inexorably linked to access to healthcare; indeed, it alone can inhibit a country’s ability to emerge from extreme poverty. World Population Day allows us to reflect not only on the sheer number of people inhabiting our planet, but also on the unavoidable links between different barometers of development. More specifically, public health solutions can help quell the aggressive cycle of population growth and that this, in turn, will open the door to further paths toward development.

The One Million Community Health Workers (1mCHW) Campaign is expanding CHW systems across Sub-Saharan Africa (SSA) in the critical countdown towards the deadline of the Millennium Development Goals in 2015.  1mCHW is expanding its partnerships and redoubling efforts in WHO-endorsed family planning programs that will have a deep impact on both health and population growth. Put simply, CHWs can provide the care to communities were healthcare is most needed, especially those that are experiencing rapid population growth. By both working in areas where populations are rapidly growing and providing communities with the tools to improve their reproductive wellbeing, CHWs present a therapeutic and prophylactic solution to population growth.

The 1mCHW campaign is well positioned to provide immediate support to communities that are in most desperate need of healthcare.  And while this care should be a cause for support in and of itself, perhaps the perspective of World Population Day will place the 1mCHW campaign in a more immediate context. A need for planetary resources is something that every human being shares; current unsustainable population growth threatens the resources on which individuals, communities, and countries all depend. In his 1963 speech at American University, President Kennedy prophetically asserted, “For in the final analysis, our most basic common link is that we all inhabit this small planet. We all breathe the same air. We all cherish our children’s futures. And we are all mortal.” The 1mCHWs Campaign is a product of this realization and more.