The Skoll Foundation recently announced, along with Johnson & Johnson Foundation and the Global Fund to Fight AIDS, Tuberculosis and Malaria, its contribution to the Africa Frontline First Catalytic Fund. This is one of our largest investments of the year and one that feels like the convergence and culmination of many years of co-investment, learning, and advocacy for community health. We wanted to take the opportunity to share with our own community why we believe this investment is so important and how others can join in.
The Africa Frontline First initiative (AFF) is focused on designing sustainable financing mechanisms, cultivating political will, and fostering country engagement in service of country-led community health systems. AFF is a collaborative effort from the Financing Alliance for Health, Last Mile Health, the Community Health Acceleration Partnership (under the WHO Ambassador for Global Strategy), and Community Health Impact Coalition, all under the leadership of President Ellen Johnson Sirleaf. The Africa Frontline First Catalytic Fund (AFF-CF), hosted by the Global Fund, is the first ‘project’ of AFF. It will provide financing to accelerate and sustain the scale up of frontline Community Health Workers (CHWs) in up to 10 African countries. The Global Fund and governments will match the private sector funding, and these funds will strengthen systems comprehensively and in direct coordination with governments who want to prioritize and lead the way in community health.
The moment is now to invest in our health workforce. Paying Community Health Workers is a moral and strategic imperative. Most Community Health Workers in Africa are women, and over 80 percent of them are not paid for their work. This is unjust and inequitable. We need to build systems that support them, especially after Community Health Workers were widely praised for their COVID-19 response and maintaining of baseline health services for their communities. Community Health Impact Coalition research shows that when CHWs were properly supported and paid during the pandemic, not only were they deployed for COVID case detection, sensitization, and management, but they maintained essential services for communities, preventing countless maternal and child deaths. Places without supported and paid CHWs lost ground in HIV, TB, Malaria, and maternal and child health. We stand in solidarity with the CHWs around the world who are advocating for themselves and leading this movement.
We have long-term, trusted relationships with the civil society partners involved in designing this fund—they are best-in-class social innovators committed to shifting systems towards greater equity and sustained change, from the grassroots to the grass tops. Meanwhile, the Global Fund has saved tens of millions of lives through shifting power to communities and investing in locally driven priorities. With its upcoming 7th replenishment, the Global Fund has recognized the importance of strong community health systems to end HIV, TB, and Malaria, as well as to prepare, inform, and respond to future outbreaks of disease. So much of what the Global Fund has helped build, from lab systems to a stronger workforce, is needed to respond to pandemics and end outbreaks before they even become pandemics.
The Skoll Foundation and philanthropy have made large contributions to community health—to innovators including the members of the Community Health Impact Coalition—which have helped test and prove out the impact of professionalized CHWs and assist governments to scale successful approaches. However, philanthropy cannot and should not be the primary supporter of this workforce in the long run. To be sustained and to save lives, community health needs a combination of domestic, private sector, bilateral, and multilateral support. Governments must own their community health plans, coordinated with the Africa CDC and African Union’s New Public Health Order. Our investment in the AFF-CF catalyzes increased Global Fund and government investment and prioritization for community health. It also supports country plans that lay a path for long-term financing and coordination with other key funders and initiatives.
At the Skoll Foundation, we see community health as a critical area across our long-term investments in health equity and in pandemic preparedness—an often-neglected part of the puzzle that can be transformational when implemented well. We believe the Africa Frontline First Catalytic Fund will help countries get on their desired path for community health—towards stronger, proximate health systems that reach people where they are. It will dignify Community Health Workers with just payment and support so that they can do their jobs—save lives in their communities, drive greater health equity, and respond to and prevent future pandemics.
While we celebrate this radical and exciting collaboration, communities and Ministries of Health will lead the hardest work still to come. We want to hear how YOU think you could contribute to this movement.
Please reach out to us here with your interest in joining the AFF Catalytic Fund, supporting its partners, or contributing in another way.
