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Letter from Josh

Time and again, I am inspired by the progress made by health workers serving their neighbors. In 2018, software applications built with the Community Health Toolkit supported 8.5 million actions by health workers in their communities, more than double the 4 million actions supported in 2017. Within the past year, these health workers carried out 1.7 million assessments for children in their family’s home and achieved a 90% facility-based delivery rate. When I look at these numbers, I remind myself of the people and stories involved – the long walk to get to a patient’s home in a remote village, the concern and subsequent relief when a community health worker has the essential medicines and guidance a family needs, and the pride of mastering tools and performing well in a newly-professionalized role serving your community. I am proud of our team, grateful to our partners, and in awe of the health workers and family members caring for people.

There are multiple reasons for grounded optimism. First, there is a groundswell of interest in the strategic, effective, and ethical use of technology in global health. The World Health Organization recently announced a new Department of Digital Health, funders collaborated on Digital Investment Principles to increase investment in government-led plans and public goods, and technical working groups are creating and operationalizing roadmaps for digital health. New data science initiatives are integrating human-centered design methods and working with communities as algorithms are developed and deployed. There is a growing understanding that technology is most effective in a supporting role, backing up a vision and design for a high-quality health system that reaches everyone. This approach is more nuanced than presenting technology as the solution, and it is much more exciting because it holds the potential to deliver for people.

Second, the field of actors in community health is making remarkable and replicable progress on seemingly intractable challenges. Organizations and government partners are publishing regularly, as summarized in this commentary and exemplified by recent results from Mali, Kenya, Liberia, and Madagascar. These results make the case for high-fidelity scale-ups.

Organizations and government partners are sharing their “secret ingredients” through the Community Health Impact Coalition and unique bilateral collaborations to advance Universal Health Coverage. The WHO released the first global guidelines for the design of Community Health Worker programs. From the US Surgeon General’s priorities list to the President of Mali’s historic commitment, community health is getting the attention it deserves. The progress and leadership give me hope that even – and perhaps especially – in the context of growing economic inequality and insecurity, good health can and should be protected and secured.

We recognize we must do things differently to translate this energy and momentum into meaningful changes in people’s lives. To deliver at the scale, speed, and quality that the cause of justice demands will require our imagination. In service of the coming revolution in health systems, we believe it is time to advance a mature and open technical ecosystem for global health. It is time to allow others to build with and build upon open-source and open-access components, encourage and support contributions and collaborations, and decentralize expertise. This is why we took pragmatic action and launched the Community Health Toolkit (CHT) late last year alongside an inspiring group of partners. We invite you to learn more about the CHT open-source project and work with us to advance global health equity.

You are making this work and progress possible by contributing your attention, talent, effort, and funding. We are deeply grateful.