{ "abstract": "Many health systems, particularly in low- and lower middle-income countries (LMICs), are lagging in their progress in achieving Universal Health Coverage and delivering on the promise of Health for All, constrained by workforce shortages, fiscal ceilings, and inadequate outreach to those lacking basic and essential services. Stark inequities in coverage of services and in health status persist. Strengthening community health worker (CHW) programs provides the fastest and most cost-effective route for health systems to achieve their full potential. CHWs should become the backbone of primary health care (PHC) and the foundation of health systems. Evidence from more than a decade of national-scale experience demonstrates that CHWs who are appropriately trained, paid, equipped, and supervised can extend high-quality essential services to the last mile while improving the overall efficiency of the health system. We are at a point in time when donor strategies and private investment are captivated by the promise of digital health and artificial intelligence. The most reliable approach to saving more lives is still a paid, supported CHW empowered with digital tools. At the same time, the contraction of Official Development Assistance (ODA) creates both risk and opportunity. ODA must pivot from supporting services to catalytic capital: time-bound, matching investments that accelerate governments’ own proCHW policy. A “next generation” of CHW programs in LMICs would enable CHWs to visit every home monthly and provide a broad array of PHC services as a result of adequate remuneration and appropriate training, supervision, logistical support, and integration into the health system. This could yield a highly favorable economic return—through productivity gains from better health, reduced health-care expenditures, and pandemic-risk mitigation. A “next generation” of CHW programs is our best bet for accelerating progress in achieving Universal Health Coverage and Health for All sooner rather than later.", "abstract_shown": true, "affiliations": [ "Johns Hopkins University, Baltimore, Maryland, United States of America.", "Society for Education, Action, and Research (SEARCH), Gadchiroli, Maharashtra, India.", "University of Alberta, Edmonton, Alberta, Canada.", "Community Health Impact Coalition (CHIC), London, United Kingdom.", "Icahn School of Medicine at Mount Sinai, New York, New York, United States of America.", "Columbia University, New York, New York, United States of America.", "International Institute for Primary Health Care - Ethiopia, Addis Ababa, Ethiopia.", "BRAC University, Dhaka, Bangladesh.", "County Government, Kiambu, Kenya.", "Division of Global Health Equity, Department of Medicine, Mass General Brigham and Harvard Medical School, Boston, Massachusetts, United States of America.", "Flagship Pioneering, Cambridge, Massachusetts, United States of America." ], "article_type": "Essay", "arxiv": null, "author_total": 9, "authors": [ { "affs": [ 0 ], "name": "Henry B Perry", "orcid": "0000-0003-0561-0492" }, { "affs": [ 1 ], "name": "Abhay Bang" }, { "affs": [ 2 ], "name": "Steve Hodgins", "orcid": "0000-0001-8365-3311" }, { "affs": [ 3, 4 ], "name": "Madeleine Ballard", "orcid": "0000-0003-0107-4047" }, { "affs": [ 5 ], "name": "Jeffrey D Sachs" }, { "affs": [ 6 ], "name": "Abnet Z Muluneh" }, { "affs": [ 7 ], "name": "Mushtaque Chowdhury" }, { "affs": [ 8 ], "name": "Mark Mwenda", "orcid": "0009-0005-0118-2920" }, { "affs": [ 9, 10 ], "name": "Raj Panjabi", "orcid": "0000-0003-3628-0107" } ], "bibtex": "https://research.draconitic.com/paper/d3s1synbhgnqs.bib", "cited_by": 0, "doi": "10.1371/journal.pgph.0007545", "fulltext_url": "https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007545", "id": "d3s1synbhgnqs", "issns": [ "2767-3375" ], "landing_url": "https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007545", "language": "eng", "licence": "CC-BY", "licence_label": "CC BY", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "heading", "Blood Pressure" ], [ "heading", "Earth Sciences" ], [ "heading", "Economic Geography" ], [ "heading", "Economics" ], [ "heading", "Essay" ], [ "heading", "Geography" ], [ "heading", "Global Health" ], [ "heading", "Health Care" ], [ "heading", "Health Care Facilities" ], [ "heading", "Health Care Policy" ], [ "heading", "Health Economics" ], [ "heading", "Health Systems Strengthening" ], [ "heading", "Human Families" ], [ "heading", "Hypertension" ], [ "heading", "Labor Economics" ], [ "heading", "Low and Middle Income Countries" ], [ "heading", "Medicine and Health Sciences" ], [ "heading", "Public and Occupational Health" ], [ "heading", "Salaries" ], [ "heading", "Social Sciences" ], [ "heading", "Sociology" ], [ "heading", "Vascular Medicine" ], [ "plos", "/Earth sciences/Geography/Economic geography/Low and middle income countries" ], [ "plos", "/Medicine and health sciences/Health care/Health care facilities" ], [ "plos", "/Medicine and health sciences/Health care/Health care policy/Health systems strengthening" ], [ "plos", "/Medicine and health sciences/Health care/Health economics" ], [ "plos", "/Medicine and health sciences/Public and occupational health/Global health" ], [ "plos", "/Medicine and health sciences/Vascular medicine/Blood pressure/Hypertension" ], [ "plos", "/Social sciences/Economics/Economic geography/Low and middle income countries" ], [ "plos", "/Social sciences/Economics/Health economics" ], [ "plos", "/Social sciences/Economics/Labor economics/Salaries" ], [ "plos", "/Social sciences/Sociology/Human families" ] ], "openalex": null, "pdf_url": "https://journals.plos.org/globalpublichealth/article/file?id=10.1371/journal.pgph.0007545&type=printable", "pmcid": "PMC13722326", "pmid": "42961960", "published": "2026-10-30", "publisher": "Public Library of Science", "ris": "https://research.draconitic.com/paper/d3s1synbhgnqs.ris", "sources": [ { "first_seen": "2026-10-31T12:20:55Z", "native_id": "10.1371/journal.pgph.0007545", "source": "plos", "url": "https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007545" }, { "first_seen": "2026-11-02T03:21:21Z", "native_id": "MED:42961960", "source": "europepmc", "url": "https://europepmc.org/article/MED/42961960" }, { "first_seen": "2026-11-03T12:22:51Z", "native_id": "PMC13722326", "source": "pmc", "url": "https://doi.org/10.1371/journal.pgph.0007545" } ], "subjects": [ { "field": "earth", "origin": "heading:Earth Sciences", "subfield": "general" }, { "field": "medicine", "origin": "plos:global health", "subfield": "epidemiology-public-health" } ], "title": "The potential of a “next generation” of community health workers to accelerate progress in reaching Universal Health Coverage and Health for All", "title_text": "The potential of a “next generation” of community health workers to accelerate progress in reaching Universal Health Coverage and Health for All", "type": "peer-reviewed", "updated_at": "2026-11-03T12:22:51Z", "url": "https://research.draconitic.com/paper/d3s1synbhgnqs", "venue": "PLOS Global Public Health", "versions": [] }