{
  "abstract": "Introduction Community health worker (CHW) programmes are central to primary healthcare (PHC) in sub-Saharan Africa (SSA). Yet who pays for them, how much, and whether funds favour vertical (single-disease) or horizontal (broader-focus) programmes remains unclear. This study examined trends in donor and government financing for CHW programmes across SSA.Methods We conducted a secondary analysis of publicly available data. Organisation for Economic Co-operation and Development Creditor Reporting System (2002–2022) projects were screened and classified as vertical or horizontal through standard definitions and manual review. Government spending in 37 SSA countries (using WHO Global Health Expenditure Database (2016–2022) was estimated by applying maturity-based allocation percentages to preventive and outpatient curative functions. We described trends, donor composition, vertical–horizontal shares and the annual financing gap against published cost benchmarks.Results Between 2002 and 2022, global external assistance for CHW programmes totalled US$14.4 billion, SSA receiving 76% (US$11.0 billion). Of donor funds to SSA, 76.4% supported vertical programmes, although these made up fewer than 20% of projects; horizontal programmes received just 14.7%. Annual external assistance rose from ~US$0.28 billion (2016–2019) to ~US$1.83 billion (2020–2022), with over 90% directed to vertical or COVID-19-related efforts. Government spending across 37 SSA countries totalled ~US$1.4 billion (2016–2022). This represented less than 20% of total CHW funding but a greater share directed to horizontal services (54.6%). The annual financing gap remained between US$4.7 billion and US$4.3 billion.Conclusions CHW financing in SSA is donor-dominant and vertically oriented; domestic allocations are limited but relatively more horizontal. Closing the funding gap will require larger, predictable government budgets for CHWs, better-aligned partner support and stronger expenditure tracking to sustain PHC and advance universal health coverage.",
  "authors": [
    {
      "affiliations": [
        "Financing Alliance for Health, Nairobi, Kenya",
        "London School of Hygiene & Tropical Medicine, London, UK"
      ],
      "name": "Shivani Shukla"
    },
    {
      "affiliations": [
        "Research Xcellas Glocal Solutions, Gaborone, Botswana",
        "Partners In Health, Monrovia, Liberia"
      ],
      "name": "Lucia Mupara"
    },
    {
      "affiliations": [
        "Financing Alliance for Health, Nairobi, Kenya"
      ],
      "name": "Soleine Scotney"
    },
    {
      "affiliations": [
        "Division of Global Health Equity, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA",
        "Partners In Health, Boston, Massachusetts, USA"
      ],
      "name": "Daniel Palazuelos"
    },
    {
      "affiliations": [
        "Research Xcellas Glocal Solutions, Gaborone, Botswana"
      ],
      "name": "John Mogaka"
    },
    {
      "affiliations": [
        "Community Health Impact Coalition, Seattle, Washington, USA"
      ],
      "name": "Carey Carpenter Westgate"
    },
    {
      "affiliations": [
        "Community Health Impact Coalition, Seattle, Washington, USA"
      ],
      "name": "James O’Donovan"
    },
    {
      "affiliations": [
        "Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"
      ],
      "name": "Bill Brieger"
    },
    {
      "affiliations": [
        "Ministry of Health, St. George’s, Grenada"
      ],
      "name": "Christine La Grenade"
    },
    {
      "affiliations": [
        "Financing Alliance for Health, Nairobi, Kenya"
      ],
      "name": "Parfait Uwaliraye"
    },
    {
      "affiliations": [
        "Financing Alliance for Health, Nairobi, Kenya"
      ],
      "name": "Dennis Munguti"
    }
  ],
  "title": "Trends in government and donor funding for vertical and horizontal community health worker programmes in sub-Saharan Africa",
  "uid": "deb83ffd-52e6-5bbf-946b-49f540078052"
}