Community health worker (CHW) programs have already transformed primary health care (PHC), improving health outcomes across a number of countries. The evidence from programs at national scale is still varied, but there is growing global consensus, based on evidence from several countries, that CHW programs have made vital contributions to rapid progress in improving health.

In China, the forebearer of all CHW programs, CHWs helped the country achieve the eradication of smallpox, and double life expectancy. In Bangladesh, Brazil, and Nepal, CHWs have been a key factor in accelerating progress in reducing under-five mortality. And in a host of countries around the world, CHWs make modern long-term family planning available. 

There is already a significant body of evidence that well-trained, well-equipped, and well-supervised CHWs - as part of integrated primary health care teams - can have significant impact on nutrition, under-five mortality, and maternal mortality by delivering evidence-based interventions.

For example, a review of the effectiveness of CHWs in providing family planning services concluded that CHWs can safely provide birth control pills, condoms, and injectables, and effectively refer patients for other long-acting forms of contraception.  An evaluation of Mozambique’s CHW program, which serves 1.1 million people, demonstrated a one-third reduction in the prevalence of childhood undernutrition. A review and meta-analysis of RCTs revealed the odds of exclusive breastfeeding was 5.6 times higher in women who had been exposed to CHW interventions, than women who had not. A review of studies of community case management carried out by CHWs concluded that the reduction in mortality could be as high as 70 percent for pneumonia. A study in rural Pakistan found that a package of community-based interventions delivered by the country’s Lady Health Workers led to improved home care practices and increased care-seeking behavior, reducing stillbirth and neonatal mortality rates by 35 percent and 28 percent, respectively, and increased deliveries by skilled birth attendants by 67 percent. A review and meta-analysis of RCTs of CHW-led women's groups practicing participatory learning and action in Bangladesh, Malawi, Nepal, and India demonstrated a 37 percent reduction in maternal mortality. Finally, an analysis published in 2017 estimated that if the 73 countries with the heaviest disease burdens adopted tailored CHW programming focused on providing a package of 30 common evidence-based interventions to half of their population, they could prevent three million maternal, neonatal and child deaths from 2016 to 2020. (For a list of service delivery areas on which there is published evidence of CHW effectiveness, see Annex 2 of the .)