Resolving the vertical versus horizontal conundrum
The potential of a “next generation” community health worker program to accelerate progress in TB control and at the same time strengthen primary health care
Bibliographic Data
| ID | 22091867 |
|---|---|
| Authors | Henry B Perry (0000-0003-0561-0492, Johns Hopkins University), Akramul Islam (BRAC), Shayla Islam (0000-0002-0490-7799, BRAC), Farhana Nishat Seheli (BRAC), Saifur Reja (BRAC), Mirlene I Perry (Duke University), Krupa K Patel (Development Initiatives), Asif Saleh (BRAC), A Mushtaque R Chowdhury (BRAC University) |
| Year | 2026 |
| Volume | 14 |
| Pages | 1815283-1815283 |
| Publication date | 2026-04-29 |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | Frontiers in Public Health (JOURNAL) |
| Journal identifiers | ISSN: 2296-2565 • E-ISSN: 2296-2565 |
| Publisher | Frontiers Media SA (PUBLISHER • CH) |
| DOI | 10.3389/fpubh.2026.1815283 |
| PMID | 42136593 |
| OpenAlex | W7159603443 |
| Language | EN |
| References cited | 18 |
Building on the experience of the community health worker (CHW) program at BRAC, the largest NGO in Bangladesh and also in the world, as well as on the experience of other successful CHW programs, a “next generation” of CHW programs is being envisioned in which a CHW would visit every home every month. Among many other activities they would carry out, CHWs would screen for symptoms of TB, obtain sputum specimens that would be collected by a supervisor, have them read at a local government laboratory, and then ensure treatment supervision for those who test positive. This is but one example of the power of a full-throated integrated CHW program that could be implemented in low- and lower middle-income countries at a cost of $26 per capita per year and generate over 20 years a 13:1 return on investment. Unfortunately, at present progress in achieving the health-related Sustainable Development Goals is far below what is needed in order to achieve in 2030 the success that was envisioned. Investing in stronger CHW programs and strengthening community-based primary health care has the potential to accelerate progress and at the same time resolve the vertical versus horizontal conundrum
Community health · Community health workers · Health care · Per capita · Primary health care · Program evaluation · Rural health · Global Maternal and Child Health · Global Public Health Policies and Epidemiology · Healthcare Facilities Design and Sustainability
A History of Global Health
Selective Primary Health Care
The Bangladesh paradox
Costs and cost-effectiveness of integrated horizontal community health worker programmes in low- and middle-income countries (2015–2024)
Costs and cost-effectiveness of community health worker programs focussed on HIV, TB and malaria infectious diseases in low- and middle-income countries (2015–2024)
Expanding the population coverage of evidence–based interventions with community health workers to save the lives of mothers and children
| Highly cited | No |
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