When many of us picture health workers, we often think of doctors and nurses in scrubs, triaging patients in crowded hospitals or donning personal protective equipment (PPE) during pandemics. But in many countries, over half the population lives more than an hour’s walk to the nearest health facility; this is over 3 billion people in the world. In some of the world’s most vulnerable communities—in remote villages, city outskirts, and rural outposts—the people providing frontline health care are community health workers (CHWs).

From tracking infectious disease outbreaks to supporting maternal and child health, chronic illness, and mental health, CHWs are often the first, and sometimes the only, point of contact with the health system for communities. They are not only essential in times of crisis; they are indispensable every day.

Niger, Mali and El Salvador

In Niger, where access to healthcare facilities remains limited for many, CHWs reach up to 3.8 million people with essential health services. Palladium works with CHWs to distribute malaria prevention therapy to children. But they also deliver integrated community case management — diagnosing and treating common childhood illnesses such as diarrhea and acute respiratory infections. CHWs also play a crucial role in identifying and referring more complex cases, including tuberculosis and neglected tropical diseases, to health facilities for specialized care.

In Mali, CHWs are the linchpin of quarterly outreach clinics, which deliver childhood immunizations and distribute mosquito nets in hard-to-reach areas. These simple but powerful interventions help protect children before they get sick – a proactive approach that’s both cost-effective and deeply humane.

And in El Salvador, the CHW model has expanded beyond health alone. There, community workers in health, agriculture, and the environment collaborate under a “One Health” approach, recognizing that human health is deeply connected to the health of animals and ecosystems. By integrating their work, they can prevent disease outbreaks before they start – for instance, by addressing agricultural practices that contribute to zoonotic disease, or ensuring clean water access that keeps both livestock and families healthy.

Trusted Neighbors

The value of CHWs is not only in what they deliver, but in how they deliver it. They are trusted neighbors. They speak the language, understand the culture, and know the barriers people face—whether those are physical, financial, or social. That trust allows them to reach the people the health system often misses: the mother unable to bring her child to a clinic; the farmer who can’t afford to miss a day’s work; the adolescent struggling in silence with depression or anxiety.

And yet, despite their impact, CHWs are chronically underpaid, under-supported, and under-recognized. Many work long hours with limited training, supplies, or supervision. Some are volunteers, or only receive a stipend that barely covers transportation costs.

We ask them to carry the weight of the world’s most pressing health challenges—pandemics, noncommunicable diseases, and key preventative health care—but we do not invest in their wellbeing or development. This is not just unfair; it’s unwise.

If we want to build resilient, equitable health systems, we need to treat CHWs not as an add-on, but as the foundation of primary health care. That means formal recognition, adequate compensation, training, mentorship, and tools to do their job. It means integrating them fully into health systems—not only during emergencies but as a permanent, professionalized workforce.

They support us. It’s time we support them.