Fatoumata Yarie Diakité became a Community Relay, or RECO, because she wanted to help the people around her. “When I see someone understand a health message or agree to go to the health center, I know my efforts are not in vain,” she says. In the rural commune of Mambia, in Guinea’s Kindia region, Yarie travels from village to village, speaking with families about prevention, care, and treatment. In communities where many people turn first to traditional medicine, and facilities can be far away, her work begins with trust. 

She remembers a pregnant woman who lived roughly 47 kilometers from the nearest health center. It was her third pregnancy, and she had never once attended a facility. After several conversations, and with Yarie by her side, she finally agreed to go. She received antenatal care and later gave birth to a healthy child. Another time, a woman in her community was struggling to walk, her legs swollen and painful. Yarie encouraged her to seek care and stayed with her through the process. The woman recovered, and still thanks Yarie whenever they meet.

That trust runs both ways. Families ask Yarie to accompany them to health facilities. And at harvest, neighbors bring her food. When she struggles, others step in to help. It is this sense of reciprocity that keeps her going, even when resources are scarce: Yarie looks after her community, and her community looks after her. 

A Financing Gap CHWs Feel Directly

Yarie’s story is also a story about financing. Community health workers (CHWs) and Relays like her connect their neighbours to care that could otherwise be out of reach. But community health remains underfunded across Africa. In Guinea, more than 90 percent of community health financing comes from external partners. The remaining gap is roughly GNF 1 trillion, or about US$114 million.

That gap isn’t abstract. It shows up in the distances RECOs like Yarie cover on foot or in supplies bought using their own money. It’s a pattern seen across the continent: CHWs holding up essential health systems through personal sacrifice, without the pay or recognition given to other frontline health workers.

Closing the gap requires more resources. But when resources are already scarce, how they are spent matters just as much. Fragmented investments, each supporting different priorities, projects, or delivery models, can leave governments managing a patchwork of programs rather than building the systems needed to sustain community health over time. More funding alone will not solve that problem.

The goal, then, must be twofold: mobilize more financing for community health while making every dollar work toward a stronger, government-led system. The most effective investments strengthen governments’ ability to plan, finance, manage, and sustain community health, and ensure that CHWs like Yarie are recognized and supported as an integral part of that system.

Building a Pathway Toward Sustainable Financing

Guinea already had much of the architecture needed to make community health locally financed. Its decentralization framework gives communes responsibility for local development and access to revenue through local taxes, voluntary contributions, and transfers of mining revenues. What was missing was a practical way to turn community health priorities into public budget lines.

That’s where catalytic financing played a key role. Project BIRCH was a the Global Fund-funded initiative jointly led by Guinea’s Ministry of Health and Public Hygiene, through the Community Health Directorate (DNSCMT), and Ministry of Territorial Administration and Decentralization with technical support from Africa Frontline First, Integrate Health, and CJMAD. Rather than creating another parallel funding stream, it funded the technical and institutional work communes needed to use their own systems and resources. That meant costing needs, aligning ministries and local authorities, identifying available revenues, and turning political commitments into public budget lines. Partners worked with local officials in ten communes across Kindia and Mamou to assess community health needs and integrate them into local development plans, investment programs, and municipal budgets.

This process also brought national ministries, local authorities, and partners together around a shared question: what would it take for communes to finance their own community health workers?

From 2024 to 2025, that work delivered results: ten communes formally committed local public resources to community health, including funding the salaries of 114 RECOs and 15 CHWs over five years. Municipal budgets are where local governments make choices about what they consider a public responsibility, and community health is now being budgeted alongside priorities like roads, water, education, and agriculture — not treated only as something financed through temporary projects or external partners. This shift is taking place against a backdrop of municipal and legislative elections in the country, but the newly elected municipal councilors remain supportive of the work already underway.

“In Damanakia, the salaries for our RECOs and ASC agents are what we call an incompressible line. It’s held with the municipal treasurer, and every month, before any other expense, that salary goes out first,” says Ibrahima II Sylla, president of the Special Delegation of Damanakia’s Mayor’s Office, one of the ten pilot communes. “Today we have 38 community health agents working across our districts.”

BIRCH’s success led to Renforcement des Acquis Communautaires pour une Intégration Nationale Élargie (RACINE), a second phase launched in 2026. Building on the pilot’s achievements, RACINE extends the approach to 10 more communes across Kindia, Mamou, and Faranah, doubling the number of municipalities positioned to finance community health locally. And letting the second cohort benefit from the first cohort’s lessons.

For RECOs like Yarie, that’s a tangible shift. It moves her work closer to being recognized as a public responsibility rather than something sustained through personal sacrifice or temporary outside support. “When local authorities take an interest in our work and support us, we feel valued,” she says. Predictable pay means a RECO can do the job fully, instead of fitting it around what she can personally afford. The next test is not simply whether more communes make commitments. It is whether community health becomes a routine part of how local governments plan, budget, and spend.

What Health Sovereignty Looks Like

Governments across Africa are moving toward community health sovereignty. This doesn’t mean governments must finance every part of their health systems alone — it means public institutions have the authority and capacity to set priorities, coordinate partners, mobilize their own resources, and decide how those resources are used. External financing can help build that capacity rather than substitute for it.

In Guinea, that meant joint leadership from ministries and communes willing to claim community health as their own. Partners supported the process, but the resulting budget decisions belonged to the government. None of this happened by chance. The decentralization framework was mature enough for communes to take on new budget lines, and political will, from ministries to mayors, made it happen. The opportunity wasn’t to invent a new financing system for community health, but to connect it to public systems and resources that already existed. Guinea still depends heavily on external financing, and municipal capacity is uneven — commitments on paper still need to become regular payments. Pulling back just as these systems start to take shape wouldn’t speed up sovereignty. It would set it back.

Delivering on the Promise

Yarie understands why this transition matters. “Today, we benefit from the support of partners, but they will not always be there,” she says. “If local authorities continue to support the RECOs, our activities can continue.” 

The impact of BIRCH and RACINE shows us what happens when we mobilise catalytic financing, pair it with targeted technical assistance, and build the regional and country partnerships that make both stick. This is the path to community health sovereignty. And it’s the only path that upholds the dignity of CHWs and ensures every country has a community health system that delivers better health outcomes today and in the future.

Featured photo: Bintou Keita, a Community Relay (RECO) in Babila, with Fanta, a community member from Sanafran, Guinea.