Every quarter, more than 22,000 Village Health Workers (VHWs) across Zimbabwe wait for the same notification: a message on their mobile phone confirming they have been paid. Not long ago, VHWs couldn’t be sure that payment would come.
VHWs are the backbone of primary healthcare in Zimbabwe. They connect communities to health facilities, support mothers and young children, and play a central role in HIV, TB, and malaria programs. But VHWs are not part of the government’s formal health workforce, so they are not paid through government payroll. Instead, their payments have been managed through a patchwork of external partner systems. That meant a VHW’s payment depended on records held in several different places.
Today, the Ministry of Health and Child Care manages VHW payments itself, and VHWs can count on being paid, and paid on time.
When governments inherit the complexity but not the control
The previous arrangement kept thousands of VHWs working, but it was not built to last. Provincial and district teams closest to VHWs could not see or correct the records that determined who got paid. They could not confirm whether a VHW’s name, phone number, or facility was current, and they could not easily remove people who had left or fix duplicate entries. Over time, registries filled with inactive, duplicate, and outdated entries that no longer reflected the current workforce.
By early 2024, around 25 percent of VHW payments were being rejected, and nearly 5,000 cases needed follow-up to resolve. But resolving them was nearly impossible. A VHW whose payment did not arrive had no clear path for raising the issue and even if they did—the government had little visibility into the problem. Across a workforce this size, delayed or missing payments erode motivation and retention, and with them, the care communities rely on. This is a familiar issue that many countries face: systems built around partner processes deliver in the short term but leave governments without the tools to lead.
Building systems governments own
The Ministry of Health and Child Care (MoHCC) set out to bring VHW data and payments under government management. Project BIRCH, a Global Fund initiative, provided the catalytic investment. In partnership with Africa Frontline First, the Clinton Health Access Initiative (CHAI) provided technical assistance to the Ministry. The aim was to strengthen the government’s own systems so partner systems were no longer needed.
At the center of that work is the national VHW Master List: a single, government-owned source of truth for every VHW in the country. Provincial registries were consolidated, then verified at facility level and checked against mobile-money payment and registration records. Duplicate, inactive, and outdated entries were removed. Each VHW is now linked to the health facility responsible for their supervision and support, giving the Ministry a clear line of oversight from facility to community.
Alongside the Master List, payment management moved to a government-owned system. Provincial and district teams were trained to prepare and process payments through mobile money. The Ministry, Africa Frontline First, and CHAI co-created standard operating procedures, so every level of the health system follows the same steps to update records, prepare payments, and verify beneficiaries.
The results came quickly. By mid-2025, payment rejections had fallen below 5 percent, and cases needing follow-up dropped from nearly 5,000 to fewer than 20. Provincial and district teams now prepare payment files accurately and resolve queries themselves.
More than a payment system
Payment systems rarely make headlines. But they are one of the clearest tests of whether a government truly leads its community health workforce. Health sovereignty doesn’t mean doing everything alone. It means having the authority and capacity to set priorities, coordinate partners, and direct resources.
That is why the Master List matters beyond payments. VHWs have sat outside Zimbabwe’s national human resources for health (HRH) system, the government’s formal record of its health workforce. A verified, government-owned list gives the Ministry what it has lacked: an accurate count of who VHWs are, where they work, and who supervises them.
It also leads to the next step. Linking the Master List with national registries, payroll platforms, and other digital public infrastructure could automate updates and reduce manual work. More importantly, it creates a path toward integrating VHWs into the HRH system and recognizing them as a core part of the health workforce.
A model other governments can use
Knowing where community health workers are and paying them on time is a priority for governments across the continent. Zimbabwe’s approach comes down to a few transferable steps: consolidate existing registries into a single national list, verify entries at facility level, check them against mobile-money payment and registration records, link every health worker to the facility that supervises them, and put standard operating procedures in place so every level of the system follows the same process.
It shows what catalytic financing and targeted technical assistance can achieve when they are built around government systems. External support becomes a bridge, not a substitute. Every health worker paid on time through a government-owned system moves Zimbabwe closer to a future where the people who deliver care are valued as the professionals they are.
