Millennium Villages Community Health Worker Training Program

Partnership Objectives

  1. Improve access to primary health care in rural areas of sub-Saharan Africa.
  2. Design a management system of community health workers to ensure quality care.
  3. Make policy recommendations to professionalize and pay CHWs.

The Millennium Villages are proving that by fighting poverty at the village level through community-led development, rural Africa can achieve the Millennium Development Goals. The Millennium Villages are proving that by fighting poverty at the village level through community-led development, rural Africa can achieve the Millennium Development Goals. Copyright Earth Institute Columbia University

What are the health needs and challenges?

Africa has the greatest proportion of people living in extreme poverty — more than 32 percent or roughly 300 million people living on less than USD 1 a day. The continent’s environmental, epidemiological and geographical challenges — including low-productivity agriculture, a high disease burden, and high transport costs render African countries most vulnerable to persistent extreme poverty. The majority of malaria-related deaths occur in sub-Saharan Africa, and a significant number of Africans suffer from water-related diseases and malnutrition. There is also a high rate of maternal mortality. 

Description of partnership activities and how they address needs and challenges:

Since 2009, with support of almost $2 million from the MSD*'s Merck Foundation through 2013, the Earth Institute at Columbia University has been conducting a community health worker (CHW) training program to strengthen community health services for more than 400,000 people in 10 African countries, as part of the Millennium Villages Project (MVP). The initiative aims to advance the development of a professional cadre of CHWs to fill a critical gap in the delivery of primary healthcare for rural communities throughout Africa. The program helps ensure that participating community health workers are skilled, well-trained, properly remunerated, regularly supervised and fully integrated into their countries' healthcare systems.

A component of the program is the improvement of service delivery through informed decision-making processes and rigorous information feedback loops among communities, clinics, and management systems. The MVP-designed mobile health platform, CommCare, is being used to monitor performance of the CHWs.  Compiled in a monthly performance report, these “real-time” data allow managers and program advisors to identify areas for improvement, such as the tracking of vital statistics or quality improvement of case management, and to implement targeted CHW trainings. These data also facilitate the assessment of individual CHW performance, allowing managers to incentivize or promote the highest performing CHWs and to target performance improvement efforts for lower-performing CHWs.

To take full advantage of these efforts, the MVP team will incorporate the outcomes of the CHW program successes and its most recent scale-up efforts into policy recommendations and national implementation guides for each of the 10 countries where Millennium Villages are located. In addition, the MVP team will engage the national Ministries of Health to foster health policy dialogue as a bridge to long-term, sustainable in-country support for MVP activities.

Lessons learned

The Millennium Villages Project offers an innovative model for helping rural African communities lift themselves out of extreme poverty. The Millennium Villages are proving that by fighting poverty at the village level through community-led development, rural Africa can achieve the Millennium Development Goals — global targets for reducing extreme poverty and hunger by half and improving education, health, gender equality and environmental sustainability — by 2015, and escape the extreme poverty that traps hundreds of millions of people throughout the continent.

Summary of impact through December 2013 and forward looking information:

MVP has trained approximately 900 community health workers, including 87 CHW supervisors, who are overseeing nearly 500,000 people across 14 Millennium Villages.  The expanded CHW supervisor training program provides tools for conducting observational and shadow visits to strengthen the performance of CHWs.

More recently, many of the program activities have focused on sustainability and government scalability.  For example, in early 2014, the Nigerian government launched a National CHW Scale Up initiative in Abuja, based on the MVP’s advisory work over the past two and a half years with the Government of Nigeria.  The MVP program also helped lay the foundation for a major campaign to expand CHWs and their efforts to help countries achieve the health-related MDGs. In 2013, the Earth Institute launched the One Million Community Health Worker Campaign to expand and accelerate CHW programs in sub-Saharan African countries.


*MSD is known as Merck in the U.S. and Canada


The Millennium Villages: A Pathway to Achieving MDG

Partnership information

Company(ies) MSD

Partner(s) Earth Institute at Columbia University

Type of Partner(s) Academia / Hospitals


Program Type(s) Health System Infrastructure - mHealth, Health System Infrastructure - Training

Targeted Population(s) Children, Mothers, People with low income, Women

Region(s) Sub-Saharan Africa

Number of Countries 9

Country(ies) Ethiopia, Ghana, Kenya, Malawi, Nigeria, Rwanda, Senegal, Tanzania, Uganda

Start Date 2009

More information Press Release

Completed date 2013

« This effort reduces the enormous burden of disease and under-nutrition throughout the Millennium Villages in a low-cost and systematic way. And it’s working. »

Jeffrey Sachs, Director of the Earth Institute