How Community Health Workers Can Treat Malnutrition and Advance Universal Health Coverage

In advance of the United Nations High-Level Meeting on Universal Health Coverage, Action Against Hunger, the Eleanor Crook Foundation, and UNICEF held a roundtable on Monday to spotlight community-based solutions to acute malnutrition. Panelists discussed Action Against Hunger’s groundbreaking research on this new approach. 

“Today, 50 million children under five years old suffer from acute malnutrition, yet just one in four have access to lifesaving treatment. That’s unacceptable,” said Dr. Charles Owubah, Action Against Hunger CEO. 

Too often, nutrition is left out of the global conversation about universal health coverage, despite the fact that acute malnutrition is an illness we know how to predict, prevent, and treat. 

“The treatment of severe acute malnutrition is not just about nutrition,” said Saul Guerrero, Nutrition Specialist for UNICEF. “It must be part of an integrated health policy to achieve universal health coverage.”

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Hawa, an Action Against Hunger-trained community health worker, weighs a child as a part of a routine health check up.

Photo: Toby Madden
for Action Against Hunger,

Expanding Treatment: Promising New Research 

In many countries, community health workers provide a range of primary health care services, including treating illnesses like malaria, pneumonia, and diarrhea, in an approach known as Integrated Community Case Management (iCCM). Global health guidelines currently state that community health workers can only screen for malnutrition – it is not recommended that they provide direct treatment, but instead should refer malnourished children for care at a health center or hospital. 

“Some believe that adding treatment for acute malnutrition to the workload of community health workers will be too much for them to handle,” continued Guerrero. “From what I have experienced and who I have worked with, this vastly underestimates the capacity of community health workers.”

In Mali, Action Against Hunger’s ground-breaking research with the innocent foundation expands community health workers’ package of interventions to include not just diagnosis of malnutrition, but treatment as well. Working hand-in-hand with the Malian Government, our teams found extremely promising results: 95% of malnourished children treated by community health workers in the community recovered, compared with 88% of those who were treated in health centers.

“Our study in Mali found that community health workers can provide effective treatment for cases of severe acute malnutrition without complications,” explained Djaffra Traore, Advocacy and Gender Advisor for Action Against Hunger in Mali. “Prevention and treatment of acute malnutrition has been added to the national standard package of interventions offered by community health workers – a move spearheaded by the Government.”

A girl eats Plumpy'Nut, the lifesaving ready-to-use therapeutic food that will help her recover from malnutrition. One of the major challenge facing community health workers is supplies: they need to be adequately equipped with supplies used to treat malnutrition, and the global pipeline is subject to frequent breakdowns and shortages.

Photo: Toby Madden
for Action Against Hunger,

Promising Results, but Challenges Remain

Despite the pilot project’s successes, there are still barriers to scaling up community-based programs for malnutrition – many of which require context-specific solutions and a dramatic increase in funding. More health workers are needed to reach every village and every malnourished child. In some regions, a monthly stipend to maintain and motivate the workforce can be effective. Community health workers also need to be adequately equipped with the supplies they need to treat malnutrition: the global pipeline for Plumpy’Nut, the lifesaving ready-to-use therapeutic food, is subject to frequent breakdowns and shortages.

Action Against Hunger’s team in Mali has been advocating for increased funding at the national level – currently just 1% of the country’s budget is dedicated to nutrition. At the community level, our teams have been working with local leaders to raise awareness about how to stop children from becoming malnourished in the first place. 

“We need communities to do more than buy-in – we need their active participation to prevent acute malnutrition,” said Grace Funnell, Action Against Hunger’s interim Technical Director.  

At the local level, mayors from 60 communities in Mali have demonstrated promising leadership: they have each integrated prevention of malnutrition into their five-year economic plans and included projects to promote local foods and help improve diets in their budgets. They have recruited women leaders – called the Amazons in the fight against hunger – to train mothers and to spread the word about a locally-sourced fortified porridge that has been proven effective in improving nutrition.

Clementine, an Action Against Hunger-trained community health volunteer, meets with a mother and child.

Photo: Lys Arango
for Action Against Hunger,

Beyond Mali: Achieving Universal Health Coverage

Action Against Hunger and partners are now taking what we learned from our experiences in Mali and piloting similar projects in Kenya, Niger, Mauritania, and Senegal. In each context, we are adapting tailored strategies and considering government buy-in, existing national health plans and systems, education needs for community health workers, whether community health workers are paid workers or volunteers, and other factors. 

Two decades ago, malnourished children could only receive lifesaving treatment administered by a doctor within a hospital. Now, treatment of acute malnutrition is increasingly moving to communities so that children in remote areas out of reach from traditional health systems can access it. 

Ensuring this community-based approach is scaled up globally will require a new level of commitment. As Kim Cernak, Policy and Advocacy Director for the Eleanor Crook Foundation, said: “More money and attention are not enough: we need a paradigm shift. We need creativity and ingenuity. We need to bring this issue to new audiences and reach out to the whole global health community. This is a core part of achieving universal health coverage.”

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