Nigeria faces shortage of community health workers as Africa seeks $4.3bn annually

93,000 inadequate for 240m population -FG

From Juliana Taiwo-Obalonoye and Fred Ezeh, Abuja

Nigeria is facing a shortage of community health workers to serve its population of more than 240 million people, as African governments and development partners seek $4.3 billion annually to recruit, train and sustain two million frontline health workers by 2030.

The concern came at the opening of a three-day high-level forum in Abuja on Wednesday, where health authorities warned that inadequate manpower, poor remuneration, declining international assistance and excessive dependence on foreign donors could undermine primary healthcare delivery and the continent’s ambition to achieve universal health coverage.

Minister of State for Health and Social Welfare, Dr Iziaq Salako, said Africa had made considerable progress in expanding its community health workforce but remained short of its two-million-worker target, with several countries struggling to integrate personnel into formal national health systems.

Salako, who was represented by the Director of Health Planning, Research and Statistics, John Ovayoru, disclosed that only 68 per cent of African Union member states formally recognised community health workers as part of their national health workforce, while only about half paid them through government budget lines.

He said approximately 85 per cent of African countries depended on donors for at least half of their community health workforce financing, warning that the arrangement was unsustainable without stronger domestic investment and predictable funding.

According to him, estimates presented at the forum indicated that approximately $4.3 billion annually would be required to support the continental workforce target, with every dollar invested in community healthcare capable of generating an estimated $19 in economic and social returns.

“We have not gathered to admire the problem; we have gathered to finish a promise,” the minister declared.

Salako said Africa could surpass the two-million-worker target by November 2029 if countries implemented their existing plans, provided adequate financing and strengthened institutional support for frontline personnel.

He explained that the Federal Government was expanding primary healthcare services under President Bola Tinubu’s Renewed Hope Agenda and the Health Sector Renewal Investment Initiative, with emphasis on workforce development, improved planning, professional recognition and sustainable financing.

The minister said Nigeria was working to strengthen its national community health workforce policy, establish a comprehensive personnel registry and improve the deployment and monitoring of health workers, particularly in rural and underserved communities.

He identified the Basic Health Care Provision Fund as one of the mechanisms through which government could strengthen domestic financing and reduce dependence on external assistance.

Salako urged participating countries to produce properly costed implementation plans, establish measurable targets and incorporate community health workforce financing into national budgets.

He also called on development partners to align their interventions with national priorities, provide predictable long-term assistance and strengthen existing government systems rather than replace domestic financing responsibilities.

The minister stressed that the Abuja Communiqué, expected to be adopted at the end of the forum on Friday, should contain specific, measurable and time-bound commitments capable of accelerating progress towards the 2030 target.

The Africa Centres for Disease Control and Prevention (Africa CDC) reinforced the warning, saying the continent could not achieve health sovereignty while depending heavily on foreign assistance to sustain essential healthcare services.

Professor Aliko Baba Ahmed, who represented the Africa CDC leadership, said only about five or six African countries substantially financed their community health programmes through domestic resources.

He called on governments to establish dedicated budget lines, integrate community health workers into public wage structures and progressively increase domestic investment.

Ahmed expressed concern over an estimated 40 per cent decline in development assistance for health since 2021, warning that continued dependence on donors could expose essential healthcare programmes to funding disruptions and weaken Africa’s capacity to respond to public health emergencies.

According to him, community health workers remain indispensable to disease surveillance, early detection of outbreaks, immunisation, maternal and child healthcare, screening for non-communicable diseases and connecting underserved communities to formal health facilities.

He said their importance becomes particularly evident during public health emergencies, when timely identification of threats and effective community engagement could prevent wider transmission.

Ahmed also stressed the need to strengthen digital health systems, expand local production of medicines and vaccines, improve preparedness and promote equitable international partnerships built around African ownership.

Beyond recruitment and financing, delegates identified delayed salaries, poor career progression, inadequate professional recognition and limited institutional support as major obstacles to retaining community health workers.

Director of the Community Health Workforce Programme at Amref Health Africa, Mieko Makai, presented findings from research involving approximately 155 community health workers and young people across Kenya, Ethiopia, Tanzania, Malawi and Burkina Faso.

She said delayed salary payments were the most frequently cited reason for considering leaving the profession in four of the five countries surveyed.

In Malawi, she disclosed, some health surveillance assistants experienced salary delays lasting up to three months, forcing them to borrow money to meet basic household needs.

Makai also cited the experience of an Ethiopian health extension worker who postponed completing her nursing education because she could not afford tuition.

“Recruiting two million health workers is a question of numbers. Keeping them is a question of whether this is a job on which a young person can build a life,” she said.

She urged African governments to guarantee prompt payment of salaries, provide affordable opportunities for professional development and establish clear career pathways that would encourage workers to remain in service.

Similarly, Co-Executive Director of Africa Frontline First, Juliet Odogwu, representing the organisation’s champion, former Liberian President Ellen Johnson Sirleaf, reaffirmed its commitment to supporting the African Union’s two-million-worker target.

Odogwu disclosed that the organisation’s catalytic fund had supported the professionalisation of more than 100,000 community health workers between 2023 and 2026 through partnerships with governments and development institutions.

She said the organisation was working towards supporting the professionalisation of 200,000 workers by 2030, with accelerated interventions planned between 2026 and 2028.

UNICEF’s Director of Global Health Practice, Helga Fogstad, said community health workers should be regarded as the first point of contact in healthcare delivery rather than merely the last link between health institutions and communities.

She warned that weak community healthcare systems continued to undermine efforts to reduce preventable newborn and child deaths across Africa.

According to her, stronger community health services could contribute significantly to addressing the continent’s estimated 2.3 million preventable newborn deaths and improving child survival in 45 countries currently falling behind global targets.

Fogstad called for fair remuneration, supportive supervision, essential medical supplies, digital tools, career development and stronger community ownership.

She also disclosed plans for a Continental Community Health Scorecard and Learning Platform to establish performance baselines, monitor progress and strengthen accountability among participating countries.

The International Federation of Red Cross and Red Crescent Societies pledged technical assistance, community engagement and volunteer support to complement government-led programmes.

Its representative, Dr Asha Mohammed, highlighted the importance of community volunteers in identifying health threats, communicating risks and supporting emergency responses, while urging governments to integrate community-based workers into national health systems.

Chair of the Community Health Delivery Partnership Technical Working Group, Dr Richard Kabanda, insisted that African governments must assume full responsibility for financing, implementing and sustaining the initiative.

“This is our initiative. This is our baby,” he declared.

Kabanda called for harmonised training standards, formal recognition of community health workers, effective management systems and a decisive shift from policy formulation to implementation.

The forum, attended by representatives of African Union member states, Africa CDC, UNICEF and other development partners, is expected to produce an Abuja roadmap and financing commitments aimed at accelerating community health workforce development and progress towards universal health coverage.

Participants maintained that achieving the two-million-worker target would require more than recruitment, stressing that governments must establish sustainable systems for paying, training, equipping and retaining frontline personnel.