There is growing recognition worldwide of the role that community health workers can play in advancing the right to health, saving lives, and strengthening disease surveillance.

Recruited directly from their own communities, CHWs in Liberia are talented women and men who are nominated by their neighbors. After a rigorous recruitment and selection process, they are then trained in infectious disease prevention and surveillance; reproductive, maternal, and neonatal health; child health with a focus on preventing the top drivers of child mortality, including pneumonia, malaria, and diarrhea; and adult health with a focus on diagnosing and treating HIV/AIDs, tuberculosis, and neglected tropical diseases. They are equipped with the supplies they need to diagnose and treat their neighbors, including a smartphone, and paid for their work as professionals.

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But CHWs don’t work alone; they are one member of a larger community health team that works to extend the reach of the primary health system to the most rural and remote communities. A vital feature of Liberia’s National Community Health Assistant Program is the pairing of CHWs with clinical supervisors, who are trained healthcare providers including nurses, physician’s assistants, and midwives. Based in primary care clinics, clinical supervisors visit CHWs in their communities to provide the mentorship and support they need to provide high quality community-based health services. Clinical supervisors also cultivate a vital link to the nearest clinic or hospital for patients who require higher-level care.

Ultimately, the 4 S’s—skills, salary, supervision and supplies are the critical components of a CHWs’ success.

It’s not just in Liberia that this supervision model has demonstrated success. According to the Community Health Impact Coalition, supervision is critical to ensuring CHWs can deliver quality healthcare. In addition, a systematic review across 16 low- and middle-income countries found that “the most frequently cited enabling factor in the program design and management category was consistent management and supervision of CHWs.” Regular, field-based clinical supervision, which is the backbone of Liberia’s national program, was a critical determinant of success among a diverse set of geographies across Africa and Asia. Conversely, weak management and supervision structures, where supervisors were not attuned to community health programs or adult learning, created barriers to program scale and success. Notably, the World Health Organization (WHO) recently cited the importance of supportive supervision for CHWs to optimize a CHW program’s impact in the WHO Guidelines on Health Policy and System Support to Optimize Community Health Worker Programmes.

Behind every effective CHW working on the frontlines of the health system is a team that ensures their work is possible. Radical collaboration for community health starts in the community, when CHWs team up with their communities and clinical supervisors to advance the right to health for their patients. Beyond supervision, the community health team also includes the many people who make skills, supply, and salary possible—from master trainers, to supply chain experts, to national policymakers. Ultimately, the community health team powers national programs, informs global policies and best practices, and fuels evidence for advocacy.

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