In this article published in the monthly, peer-reviewed scientific journal Bundesgesundheitsblatt, R4D’s Amy Nye and partners Alexandre Delamou, Fassou Mathias Grovogui, Facely Camara, Delphin Kolié, Tohaninzé Goumou, Lior Miller and Thomas Bossert explore the crucial role of community health workers (CHWs) in achieving universal health coverage (UHC) in low- and middle-income countries (LMICs), particularly through their involvement in community mobilization, service delivery and crisis response. Many LMICs, including Guinea, have adopted decentralization reforms to enhance local governance, improve accountability and better allocate health resources. However, local actors often face significant barriers such as limited capacity, inadequate resources and continued central control, which can hinder effective implementation of these reforms.
In 2017, Guinea launched its National Community Health Policy (NCHP) to align with broader decentralization efforts, delegating 14 key responsibilities to communes. By mid-2022, around 75% of communes had begun implementing the policy, with varying degrees of integration depending on local planning and external support. Previous evaluations revealed that many local actors struggled to understand or fulfill their assigned roles under the policy, exposing a gap between what the policy intends and what is practiced. To explore this discrepancy, the study employs the decision space framework to analyze the implementation of the NCHP in Guinea between 2017 and 2021.
The paper is part of the USAID-funded, Results for Development-led Health Systems Strengthening Accelerator in collaboration with the Centre National de Formation et de Recherche en Santé Rurale, the African Center for Excellence at the Gamal Abdel Nasser University, the Guinean Ministry of Public Health and Hygiene, as well as the Harvard T.H. Chan School of Public Health.
