Addressing Malnutrition: The Power of Community Health Workers

For many families, accessing basic health services can be a daunting challenge. And community health workers (CHWs) are playing an important role to bridge the gap between healthcare institutions and the communities they serve. They’re unsung heroes serving as a lifeline in their communities, providing trusted, compassionate care and enhancing access to primary care for millions of households.

Assisting families to identify, address and prevent malnutrition is an important part of the work CHWs do in communities and households. Malnutrition is both preventable and treatable — yet it remains widespread. Globally, 148 million children under 5 years old are estimated to be stunted (too short for age), 45 million are wasted (too thin for height), and 37 million are overweight or living with obesity. Malnutrition continues to be one of the most foundational issues on the global health agenda as well as an important topic of discussion at the 2024 World Health Summit.

So, what exactly do CHWs do and what role do they play in the greater picture of global health and malnutrition? Read on to learn more.

What Is a Community Health Worker?

When it comes to understanding the role of a community health worker, it helps to visualize healthcare as a pyramid. At the top of the pyramid are hospitals, followed by regional centers and clinics. The base of the pyramid consists of services provided at local neighborhood clinics or health posts and household care provided by CHWs. In many middle- and lower-income countries, such as Kenya and Rwanda, communities rely heavily on neighborhood health posts for services such as screenings, wound care, basic lab tests, pharmacy distribution and even child delivery. Between visits to a health post, or in communities without these neighborhood clinics, CHWs make household visits, serving as a connector between the household and the entry level healthcare system.

CHWs are local community members who have basic training in public health. They conduct home visits in the community, providing education and offering basic screenings to assess whether a referral to clinics, regional centers or hospitals is necessary. In other words, they ensure those who might not have received care at all can access essential health services. They also ensure that information or treatment received at clinics and healthcare facilities is followed through at home.

The Role of the Community Health Worker to Reduce Malnutrition

CHWs work in the communities in which they live. They know the area, understand the health difficulties present in the community and are deeply trusted by the community members. This trust is crucial for those hesitant to seek medical care due to accessibility and affordability issues or stigma related to conditions such as HIV or sexually transmitted diseases.

Most CHWs visit at least eight households daily, providing basic screenings and health education on topics such as malnutrition, sanitation, water, home gardening, family planning, vaccinations and hygiene. They can also help to arrange transportation, childcare, work schedules or address other barriers that may keep someone from seeking the help they need.

As part of their routine visits in counties in Kenya and districts in Rwanda, CHWs screen for malnutrition using a simple MUAC z-score tape to determine whether a child is at risk. The impact of the MUAC z-score tape in helping to reduce global malnutrition was discussed at length during the 2024 World Health Summit session, Scaling the Response to Global Malnutrition. Within this session, various perspectives were shared, from the community health worker to the policy level.

Kenya Ministry of Health
In Kenya, CHWs are equipped with a scale and MUAC tape — two tools necessary for identifying and tracking the issue of malnutrition across the country. Oscar Kambona from Kenya’s Ministry of Health emphasized the severity in numbers. In Siaya county, 1.3 million people reside. Of the 150,000 children under 5, 19.2% — nearly 1 in 5 — are stunted. CHWs were first introduced in 2016. Now, 10 CHWs each cover 100 households. With the MUAC z-score tapes, CHWs are able to efficiently screen for malnutrition and refer at-risk children to clinics in one household visit. Prior to the use of MUAC z-score tapes, CHWs required multiple visits to first identify the risk, confirm the recommendation with the clinic and then return to communicate the need for follow-up care.

Rwanda Health Post
Ann M’Lure Abela, head nurse at a rural health post in Bugesera District of Rwanda, plays an instrumental role in supporting pregnant women throughout their pregnancy and birth journey. Ann collaborates closely with CHWs who refer pregnant women to her health post for prenatal care. CHWs also follow up with the women at home, monitoring their nutrition and health. This is an example of a partnership that enhances health education and accessibility, making healthcare more integrated and effective at the community level.

Society for Family Health, Rwanda
With support from the government and through the work of CHWs, the prevalence of malnutrition in Rwanda has dropped in recent years. Manasseh Wandera, executive director of the Society for Family Health in Rwanda, said there has been a significant reduction in child malnutrition and stunting, from over 55% in 2020 to 35% today. The goal, he said, is to reduce this further to 15% in the next five years, and eventually to zero.

Strengthening CHW capacity is a powerful way to enhance access to care for more people and help ease the burden on healthcare workers at regional clinics and hospitals.

Abbott's Support for Community Health Workers

“Partnership among the scientific and policy communities as well as public and private sector is key to scaling the response to global malnutrition,” said Dr. Raissa Sorgho, director, Public Health Institute and advisor for Abbott Center for Malnutrition Solutions.

Abbott recognizes the crucial role of community health workers and supports their efforts through a collaboration with the Ministry of Health and the Society for Family Health in Rwanda. With more than 80% of the population living in rural areas, access to healthcare often requires a several-hour walk. Rwanda aims to have a health post within a 30-minute walking distance of every citizen by 2030 and to expand services to include basic dental, ophthalmology care and vaccinations.

Since 2018, Abbott has partnered with the Ministry of Health to redesign and build second-generation health posts and is now enhancing CHW training and ensuring CHWs have access to MUAC z-score tapes. The goal is to positively impact the communities that need it most by addressing social determinants of health, providing care coordination and strengthening capacity.

"One of the foundations of a good partnership is listening, and it's at the core of understanding the local context,” said Ann Smith, co-lead of the Abbott Center for Malnutrition Solutions. “Our local partners, with strong capabilities and deep knowledge, understand what’s needed and can best determine which solutions will work best. Partnerships that are committed to co-creation with the communities they serve can have a transformative role in creating accessible, sustainable solutions. Strengthening  capacity to address malnutrition at the primary healthcare and household level is one of the main priorities of our partnerships," said Smith.

The Future for Community Health Workers

CHWs are vital to the communities they serve. According to UNICEF, they are the heartbeat of global primary care. Despite this, many receive minimal or no pay, working mostly as volunteers. Global initiatives are working to improve their compensation and working conditions, recognizing their invaluable contributions.

Expanding primary-level care through CHWs can alleviate pressure on overburdened healthcare systems, providing essential services like basic medical care and malnutrition screening. Supporting and expanding the work of CHWs worldwide is crucial to ensure everyone has access to necessary healthcare.

Learn more about how Abbott is helping to strengthen capacity for CHWs.