When caseloads matter: Community health workers, home visits, and child survival in Mali
Community health workers (CHWs) increasingly play a central role in delivering essential primary health services in low-income settings.
- community health workers
- children
By James Allen IV February 6, 2026
Community health workers (CHWs) increasingly play a central role in delivering essential primary health services in low-income settings. By providing doorstep services such as diagnosis and treatment of childhood illnesses, health promotion, and referrals, CHWs are widely viewed as a promising and cost-effective way to extend health systems to underserved populations (Bhandari et al., 2012; Gaye et al., 2020; Whidden et al., 2023). Yet important questions remain about how these programs should be structured to achieve the greatest health gains where resources are severely limited.
One fundamental question concerns the number of people that CHW should be responsible for—that is, their caseload. In practice, CHW caseloads vary widely, both across countries and within them. Program guidelines often specify target population-to-CHW ratios, but these benchmarks are typically based on planning norms rather than empirical evidence. In fragile and conflict-affected settings, where health systems are strained and resources are limited, getting this ratio right is especially important. If caseloads are too large, CHWs may be unable to provide frequent or high-quality services. If they are too small, scarce resources may be used inefficiently.