Abstract
Community health workers (CHWs) increasingly occupy a central place in primary health care systems and in health-system strengthening across Africa, but the existence of national policies and programs does not automatically translate into sustainable integration. This study assessed the CHW integration profile. We conducted a descriptive cross-sectional analysis of the situation of community health workers (CHWs) in the Republic of Congo, using data from the Africa CDC/UNICEF survey on the community health landscape in Africa (2024–2025). The national situation was examined across four domains: policy and governance; financing and sustainability; operational capacity and professionalization; and information systems and community anchoring. Data from other participating Member States were used to situate the Congolese context and identify relevant African experiences. Congo had all mechanisms assessed (costed national strategy, designated entity, coordination platform) as the majority of countries in the region. None of the resources mobilized were domestic, and neither an investment case nor a financial sustainability plan existed. A total of 26.3% of the national deployment target (2,443/9,289 CHWs) had been reached, against a regional median of 46.1%. CHW density was 0.49/1,000 population versus 0.74/1,000. Refresher-training and career-advancement mechanisms were absent. Congo had an exhaustive digital registry and strong community involvement, above regional medians, but lacked a formalized continuous quality-improvement mechanism, as in 29% of countries in the region. The Republic of Congo has built substantial policy, institutional, and community foundations for CHW integration, but institutionalization remains incomplete. Priority gaps concern domestic financing, workforce scale-up, professional development, and incorporation of CHW remuneration into public financing arrangements. Consolidating these foundations while strengthening sustainable financing will be essential to moving from a functional program to durable integration within the health system.
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