One health and community health workers: Bridging the gap in global health resilience

Emerging zoonotic outbreaks associated with viral spillovers, including Mpox and Marburg virus, have exposed critical vulnerabilities of One Health (OH) systems, particulary in low- and middle-income countries (LMICs). Key deficiencies include fragmented multisectoral laboratory networks, suboptimal cross-sectoral coordination and data sharing, limited workforce capacity, and persistent financing constraints, all of which undermine early warning systems, risk assessment and outbreak preparedness [1]. Although many LMICs have adopted OH policies, implementation remains uneven and largely non-operational. Notably, only 48% of African countries have formally integrated OH into national agendas, highlighting the urgent need for a unified continental framework to accelerate implementation and strengthen regional health security [1].

While the OH approach is gaining traction as a multisectoral strategy to address health threats at the human-animal-environment interface, one critical element remains conspicuously absent from many national frameworks: the full recognition and integration of community health workers (CHWs). Worldwide, more than 3.3 million CHWs are on the frontlines, providing essential primary health care (PHC), health education, surveillance, and referrals within their own communities [2]. In East Africa, for instance, CHWs have been integrated in healthcare system, playing a crucial role in managing epidemics and outbreak, including the recently and effectively controlled Marburg Outbreaks in Rwanda and Tanzania [3]. In sub-Saharan Africa, CHWs were instrumental in mitigating the Ebola outbreak (2014–2016), facilitated the containment of COVID-19 by contact tracing, and managed Mpox, cholera and measles outbreaks [4]. Implementation of the Lusaka Agenda has underscored the pivotal role of CHWs in strengthening PHC and enhancing outbreak response capacities [5]. Evidence from Rwanda's mature polyvalent CHW programme indicates that early case detection, community-based surveillance, risk communication, and timely referral that contribute to reduced disease transmission and mitigation of peak demand on health system resources [6]. Yet, these contributions often go unrecognized—both in terms of data attribution and policymaking inclusion. CHWs are positioned in the communities they live in daily and streamline the achievement of universal health coverage and more importantly act as early warning sentinels and proficient communicators, facilitating swift, culturally relevant responses to health treaths.

Regardless of the important role and notable impact of CHWs in their local areas, their integration into the National One Health frameworks (OHFs) remains limited and poorly developed thus limiting their engagement [7]. This absence is not just a policy blunder but also a squandered chance to establish a robust, community-centered early warning system.

More recently, the continent-wide response to the Mpox epidemic co-led by Africa CDC and WHO has documented how CHWs served as unofficial yet indispensable players in health surveillance, as highlighted in the current Mpox Situation Reports [8]. CHWs have assumed a vital albeit unofficial role in case reporting and testing guidance; nevertheless, their contributions remain inadequately recorded and unincorporated into formal systems. This exclusion is more than a policy oversight, it's a missed opportunity. While 75% of new infectious diseases are zoonotic, the underutilization of CHWs in one health surveillance and epidemic response readiness is alarming [9]. Incorporating CHWs into national OHFs via specialized training, data-sharing platforms, and involvement in veterinary-public health can enhance early detection and response.

This letter calls for revisiting community-level health policy to formally recognize CHWs as as integral to community-based surveillance, outbreak detection, and epidemic preparedness and response. Currently, CHW training primarily focuses on routine PHC functions within the human health sector. Under a OHF, CHW training should be expanded beyond conventional PHC functions to include continuous capacity building in zoonotic diseases, antimicrobial resistance, basic animal health, climate-sensitive illnesses, and multisectoral risk communication. Training should also incorporate the use of digital platforms and electronic surveillance systems to enable timely cross-sectorial data reporting. This strengthened training approach aligns with revised Event-Based Surveillance (EBS) guidelines adapted from the Africa CDC EBS framework (2023), which emphasises community-level event detection and coordination across human, animal, and environmental health sectors [10,11].

Ultimately, failure to formally integrate CHWs into One Health systems not only weakens epidemic preparedness but also undemines moral commitments to inclusive, locally led health governance. The OHFs require practical integration in overreaching policies to genuinely embrace CHWs potentials. Addressing this gap goes beyond policy considerations, but rather speaks to a morally responsible mandate toward constructing truly resilient health systems for future.

CRediT authorship contribution statement

Claude Mambo Muvunyi: Writing – review & editing, Writing – original draft, Validation, Project administration, Methodology, Investigation, Conceptualization. Pierre Gashema: Writing – review & editing, Writing – original draft, Validation, Project administration, Methodology, Investigation, Conceptualization. Emmanuel Edwar Siddig: Writing – review & editing, Writing – original draft, Validation, Project administration, Methodology, Investigation, Conceptualization. Jean de Dieu Harelimana: Writing – review & editing, Writing – original draft, Validation, Project administration, Methodology, Investigation, Conceptualization. Jean Kaseya: Writing – review & editing, Writing – original draft, Validation, Project administration, Methodology, Investigation, Conceptualization.

Declaration of competing interest

We declare that there are no conflicts of interest.

Data availability

No data was used for the research described in the article.