By Moses Akwashiki,
Abuja
More than 80 percent of Community Health Workers across Africa operate without formal salaries, a situation labour leaders say threatens the foundation of healthcare delivery across the continent.
The Chairperson of the West African Health Sector Unions Network (WAHSUN), Dr. Kabiru Ado Sani Minjibir, made the disclosure while addressing delegates at the 25th Plenary Session of the network, describing the condition as “a structural injustice hidden in plain sight.”
According to him, Community Health Workers many of whom serve as the first and only point of care in rural communities remain largely unrecognised in formal labour systems despite carrying a significant burden of healthcare delivery.
“These workers wake before dawn, walk kilometres to reach patients, administer vaccines, and provide maternal care under extreme conditions,” he said. “Yet, most return home without pay, without contracts, and without any formal recognition. Governments label them volunteers, but in truth, they are the backbone of our primary healthcare systems.”
Dr. Minjibir noted that the crisis goes beyond wages, warning that it reflects deeper structural failures in Africa’s health systems.
He cited data indicating that while Africa holds about 10 percent of the world’s population and 25 percent of its disease burden, it has access to only about 4 percent of the global health workforce.
He added that the continent’s health worker density remains far below global standards, with an average of 1.55 workers per 1,000 people significantly short of the 4.45 threshold recommended for effective healthcare delivery.
The WAHSUN chairperson also highlighted the gender dimension of the crisis, noting that the majority of Community Health Workers are women whose labour continues to be undervalued.
“This is not just a workforce issue; it is a gender justice issue. The systemic neglect of these workers mirrors the broader undervaluation of women’s work across our societies,” he said.
Beyond poor remuneration, Dr. Minjibir identified other pressing challenges confronting the health sector, including the mass migration of skilled professionals, worsening insecurity, and chronic underfunding.
He warned that West Africa is witnessing an alarming exodus of trained health workers to Europe, North America, and the Gulf states due to poor working conditions and limited career prospects.
On insecurity, he revealed that attacks on health facilities and personnel have surged across the region, particularly in the Sahel, where violence has severely disrupted access to care. He stressed that no health system can function where workers fear for their lives.
“Safety is not a privilege; it is a prerequisite for service delivery,” he said.
Dr. Minjibir further criticised the persistent failure of African governments to meet the 2001 Abuja Declaration target of allocating at least 15 percent of national budgets to health. He noted that most countries, including Nigeria, still fall significantly short of this commitment.
“We are not asking for new promises. We are asking governments to honour commitments made over two decades ago,” he said.
He called for urgent reforms, including the formalisation of Community Health Workers into national health systems, provision of fair wages, improved working conditions, and the establishment of clear career pathways.
The WAHSUN leader also urged stronger collaboration between governments and trade unions, emphasising that unions remain critical partners in shaping responsive and resilient health systems.
“Trade unions are not obstacles. We are the most organised representation of the health workforce across every community. Governments must engage us as partners, not adversaries,” he added.
He said the outcome of the plenary would focus on concrete actions, including the development of a regional charter on the rights of Community Health Workers and renewed advocacy for increased health sector funding.
“As we deliberate, we must remember the realities our members face daily—the unpaid nurse, the overworked community health worker, and those who risk their lives in the line of duty. Our resolutions must speak directly to them,” he said.
ENDS
