Roux Prize 2024 Recipient: Community Health Impact Coalition (CHIC) CEO Dr. Madeleine Ballard

“We’re in a world now where a billion people go their entire lives without ever seeing a health worker.” -Dr. Ballard

On October 15 in London, Dr. Madeleine Ballard, on behalf of CHIC, was awarded the 2024 Roux Prize, an annual award from David and Barbara Roux and IHME that honors global health innovators who have made significant contributions to improving health outcomes around the world.

CHIC is a team of thousands of community health workers (CHWs) in 60 countries who have come together to make professional CHWs the norm by changing guidelines, funding, and policy. Half of the world’s population lacks access to essential health services. CHWs have stepped up to address this critical gap and deliver care in a way that improves access, increases equity, and saves lives.  

The Nama Wellness Community Centre in Uganda is one example of how CHWs are providing quality health care and meeting the needs of their communities. Led by CHIC member, Pauline Picho Keronyai, the Centre has delivered care to nearly 200,000 patients since its inception, specifically targeting the needs of women and children.

Despite their vital work, many CHWs remain unsalaried, unsupervised, and unequipped – they lack support needed to help their communities succeed in global health goals. Co-founded by Dr. Ballard in 2019, CHIC has played a key role in influencing guidelines, increasing funding, and advancing the development of national policies needed to make professional CHWs the norm everywhere. 

Learn more about the Roux Prize

This transcript has been lightly edited for clarity

Annet Draleru: Before community health workers were there, we had a challenge. As a community, we could move a long distance to get the services. And, at times, when you go to the health facility there is no medicine. So you end up going to the clinic, and not everyone in the community can afford money to go to the clinic. So when this program came of community health workers, in fact, it helped a lot. As community health workers we’re trained. After being trained, we’re supplied, and now we can do the services.

We are treating children under 5. We are visiting the pregnant mothers. We are doing nutrition assessment, which was not there at first.

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Dr. Madeleine Ballard leads the Community Health Impact Coalition, CHIC, founded to make professional community health workers the norm worldwide.

Madeleine Ballard: Around the world, millions of community health workers are working without recognition, without pay. 70% of those community health workers are women. You have people who are being exploited. On the one hand, they either leave or they are working, without pay, hours and hours and hours and hours a week. If they do leave, then the patients are going without care.

And, as a consequence, we’re in a world now where a billion people go their entire lives without ever seeing a health worker. Community Health Impact Coalition is a team of community health workers in 60 countries around the world who have come together to make professional community health workers the norm by changing guidelines, funding, and policy.  

Pauline Picho Keronyai: Nama Wellness was established in 2014 as a health center, a community-based health center, basically offering primary health care services.

And so that attracted a big number of women from the community. But the biggest part of it was when we joined CHIC and designed the community health workers program, based on the CHIC eight principles.

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CHIC’s eight “best practices” can be summed up as “CHWs must be salaried, skilled, supervised, and supplied.”

Prossy Muyingo: We are the doctors in the community. We are very crucial in the work of the community. I do follow- ups where necessary. I treat and refer children under 5 years for malaria, pneumonia, and diarrhea. I do family planning also. But we know through training we can be professional CHWs. So, as CHIC it’s an umbrella of CHWs globally, to make professional community health workers a reality.

This advocacy course is made up of six modules. You will get to know how to use the digital tools and join others globally.  

Madeleine Ballard: A community health worker will learn you’re not alone. You’re not just off in a far-off village by yourself. You’re actually part of a whole community of community health workers from around the world, stretching back over time and into the future.

Prossy Muyingo: So we needed to come together and you fight for a good working environment as CHWs.

Madeleine Ballard: There’s a really serious health worker shortage that’s actually getting worse. The WHO says we’re going to be short as a globe like 17 million health workers by 2030. So folks need care. We need people. And I think community health workers have really been able to step into that gap. And the biggest provider of health care in most places is the government.

Dr. Richard Kabanda: We have also made it clear to government partners and implementing partners that as a country, if we are to change the status quo from curative to promotive and preventive, as a country, we’ve taken a decision that community health workers is the way to go.

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Community health workers are a proven cost-effective solution to last-mile health care needs.

Pauline Picho Keronyai: We’ve seen that community health workers can actually increase access to basic health care services. They can increase and promote equity in their community.

Madeleine Ballard: We’re living in a digital world, right? And the temptation is always to say, oh, let’s fix that with an app or a drone or something. And these tools are amazing, right? And they can really support us in reaching more people more easily.

At the same time, I think people know, pretty intuitively, that you trust your neighbor more than you trust the internet. So we need to advocate to get more money, better spent on professional CHWs. But in order to make that kind of global reality a reality for every community health worker in every country, that’s where these networks come in.

Pauline Picho Keronyai: We don’t want community health workers to be exploited because they cannot stand up for themselves.  

Madeleine Ballard: Let’s get community health workers in the room and let’s establish that unified voice. And they’re not just speaking for themselves. They’re speaking for 700. They’re speaking for 7,000. They’re speaking for 70,000. Now we’re really getting somewhere.  

I look forward to standing alongside you as we change the health system in Uganda.

Prossy Muyingo: Our voices have been missing. But now, the more we advocate, the more we’ll be getting that change we are praying for.  

Madeleine Ballard: Once they speak, they’re always the most powerful speaker in the room because they have that authority, they have that legitimacy, that credibility, and they have the insight that nobody else has, because they’re on the front lines every single day.

Pauline Picho Keronyai: When we bring together CHWs and we all have the same voice and use the same voice to advocate at the national level, then we believe that these changes will be seen.  

Madeleine Ballard: I’m really proud of, obviously, what we’ve achieved together as a team. I think so much of both the research and then the advocacy has changed what people think about community health workers.

If you hear 86% of community health workers are unsalaried, that’s CHIC research. Salaried, supervised, skilled, supplied produces better outcomes – that’s CHIC.

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Today more and more countries are adopting a policy to recognize CHWs as professionals.

Madeleine Ballard: Our goal is to see 95 countries recognize and pay CHWs. And what we’re seeing is a rapid acceleration, just over the last five years, in terms of the number of countries who are making the switch. We’re, you know, just over a third of the way there, we’ve got 60 countries to go. And I think we’re on track to hit that tipping point really, really soon.  

To win that commitment is so important because it’s someone finally saying, you’re right, you’re worth a lot.

Prossy Muyingo: It’s time for CHWs to take our seat, to sit with the decision-makers and the policymakers, because each and everything starts in the community where we are and ends in the community where we serve.