BIRCH Project 2024–2025: Results by Country
The BIRCH project (Building Integrated Readiness for Community Health) is a Global Fund initiative implemented in 2024 and 2025 with technical assistance from ICHESS in seven countries. It aimed to durably strengthen community health systems and to maximize the impact of GC7 and C19RM grants on HIV, tuberculosis, malaria and health emergency preparedness. The results achieved in each country are presented below. See also: the 2022 strategic initiative in Congo, CAR, Chad and Mauritania.
Republic of the Congo – ICHESS results and impact
In the Republic of the Congo, ICHESS technical assistance equipped the Directorate of Primary Health Care (DSSP) with a complete set of strategic tools: the 2025–2030 National Community Health Strategic Plan (PSNSC), the 2025 Community Health Operational Plan, a 2021–2024 investment mapping and a 2026–2035 Financial Sustainability Plan (FSP). Between 2024 and 2025, operational plan execution rose from 40% to 56% and budget mobilization from 51% to 64.5%. The FSP sets a path towards a 50% national share of community health financing by 2035.
Key figures
56%
Programmatic execution rate of the 2025 operational plan (40% in 2024)
64.5%
Budget mobilization for the 2025 operational plan (51% in 2024)
750
CHWs trained in event-based community surveillance (2024)
7,868
CHWs targeted for 2035 in the costed deployment plan (2,366 active today)
Main interventions and results
- Operational planning: The 2024 operational plan was realigned to include BIRCH activities, followed by a 2025 plan with 41 prioritized activities, of which 23 were fully and 7 partially completed.
- System maturity: Foundational elements analysis: system rated “partially functional”, with governance and service delivery now functional. Capacity assessment of DSSP staff.
- Strategic framework: Evaluation of the 2021–2024 PSNSC (highly relevant, limited execution) and development of a second-generation 2025–2030 PSNSC.
- Community health workforce: Costed deployment plan: from 2,366 active CHWs to 5,118 in 2030 and 7,868 in 2035. Better supply of malaria rapid diagnostic tests for CHWs through C19RM/GC7.
- Sustainable financing: 2021–2024 investment mapping (97.5% dependence on technical and financial partners for the projected 2025 budget), investment case and 2026–2035 FSP targeting 50% national financing by 2035.
Republic of Niger – ICHESS results and impact
In Niger, ICHESS supported the Directorate of Community Health (DSC) in consolidating an already well-structured system: the 2024 self-assessment shows that 84.6% of foundational elements are in place. The 2025 annual action plan (about FCFA 1.22 billion) is aligned with funding from the Government, UNICEF and the Global Fund. The 2026–2035 FSP targets 56.5% national ownership of financing by 2035.
Key figures
84.6%
Foundational elements of the community health system in place (2024 self-assessment)
FCFA 1.22 bn
2025 DSC annual action plan budget, aligned with GC7
FCFA 480 m
Mobilized by the Government in 2024 for community relay incentives
56.5%
National share of financing targeted for 2035 (FSP, medium scenario)
Main interventions and results
- System maturity: Participatory 2024 self-assessment covering policy, strategies, standards, supervision and data: 84.6% of elements in place, system “partially functional” at an advanced stage.
- Planning and budget: Development of the DSC 2025 annual action plan, with a budget structured by expenditure category (operations, training, investment) and funding source.
- Sustainable financing: Comprehensive investment mapping and 2026–2035 FSP with progressive scenarios for domestic resource mobilization.
- Community relays (RCom): Work with the Human Resources Directorate on formal recognition of community relays, with their status and incentives built into the FSP.
- Governance: Weekly and monthly meetings at the DSC and quadripartite coordination between ICHESS, principal recipients, the DSC and the Global Fund/BIRCH.
Islamic Republic of Mauritania – ICHESS results and impact
In Mauritania, BIRCH supported the relaunch of community health around the Directorate of Community Health. Availability of the system's foundational elements rose from 44% in 2024 to 64% in 2025, and the number of trained CHWs doubled. The 2026–2035 FSP plans for the Government's contribution to grow from 20% in 2026 to full coverage by 2035.
Key figures
44% → 64%
Foundational elements in place between 2024 and 2025 (+20 points)
748
CHWs trained (371 at baseline); 823 in training, some of whom are already counted among those trained
1,115
CHWs targeted by the national programme
20% → 100%
Government share of financing between 2026 and 2035 (FSP)
Main interventions and results
- System maturity: Foundational elements inventory and maturity assessment in 2024 and 2025; the tool is now used at central and decentralized levels for dialogue and prioritization.
- Operational planning: Ongoing support for developing and adjusting the 2024 and 2025 operational plans, with monitoring and evaluation coaching for central and regional teams.
- Community health workforce: Rapid scale-up of trained CHWs, prioritizing localities more than 5 km from a health facility.
- Sustainable financing: Investment mapping and 2026–2035 FSP: Government commitment to fully finance community health by 2035.
- Governance: Weekly and monthly meetings at the DSC and a tripartite coordination framework between ICHESS, the PR/DSC and the Global Fund/BIRCH.
Republic of Madagascar – ICHESS results and impact
In Madagascar, ICHESS supported a phase of consolidation and reorientation of community health, in a context of remote areas and recurrent climate shocks. The 2024 maturity diagnostic and the review of the 2019–2023 roadmap led to a new 2026–2030 programme aligned with the 2021–2030 PSNSC. A national investment mapping and operational plans aligned with the Global Fund complete this foundation.
Key figures
2024
In-depth maturity diagnostic of the community health system
2026–2030
New community health roadmap, aligned with the PSNSC and the national health development plan
1
National mapping of community health investments
Plans
Annual operational plans aligned with the Global Fund and partners, with budgeted targets
Main interventions and results
- System maturity: 2024 diagnostic covering governance, community workforce, financing, data and supply chain, taking into account population dispersion and exposure to cyclones, floods and droughts.
- Strategic framework: Critical review of the 2019–2023 roadmap and a new 2026–2030 programme aligned with the 2021–2030 PSNSC and the national health development plan.
- Community agents: Standardization of profiles, roles and service packages; planned increase in community agents in remote rural areas, with close supervision.
- Financing: Investment mapping: existing funding, areas covered and gaps, as the basis for a future investment case.
- Operational planning: Operational plans aligned with Global Fund and other partner grants, with performance indicators and attention to areas exposed to climate shocks.
Republic of Chad – ICHESS results and impact
In Chad, ICHESS supported the Directorate of Community Health in strengthening the system's foundations: 10 of 16 key elements were in place in 2025 (62.5%), above the 60% target. The integrated 2025 Community Health Operational Plan (FCFA 4.79 billion) brings together the DSC, national programmes and partners. The 2026–2035 investment case costs the scale-up at FCFA 167.2 billion, about USD 1.2 per person per year.
Key figures
62.5%
Key community health system elements in place in 2025 (10 of 16), above the 60% target
FCFA 4.79 bn
Integrated 2025 operational plan budget, of which FCFA 2.57 bn mobilized (53.7%)
7,262 → 36,519
Operational CHWs in 2025 and total estimated need by 2030
USD 1.2
Average cost per person per year of the community health model
Main interventions and results
- System maturity: 2024 inventory and 2025 assessment using the MEAP-ASC tool: progress in governance, leadership and planning, community workforce and service delivery.
- Operational planning: The 2024 plan was realigned, followed by an integrated 2025 plan built around 9 priority problems, tracked through quarterly reports and bottleneck analysis.
- Community health workforce: DSC capacity analysis; plan to recruit 29,513 new CHWs by 2030; monthly incentive of FCFA 25,000 included and budgeted.
- Strategic framework: Evaluation of the 2021–2025 PSNSC and development of the 2026–2030 PSNSC, the sector's new reference framework.
- Sustainable financing: 2021–2025 investment mapping (USD 8.86 million spent); 2026–2035 investment case and financing plan of FCFA 167.2 billion, about 85% of it for the community workforce.
South Sudan – ICHESS results and impact
In South Sudan, ICHESS technical assistance helped the Ministry of Health bring order to a highly fragmented community system largely driven by humanitarian actors. The country had 11,484 Boma Health Workers and 624 supervisors at the end of 2025, with a target of 28,755 BHWs and 1,438 supervisors by 2030. The 2026–2035 FSP sets a realistic first milestone of 15% domestic financing by 2035.
Key figures
11,484
Boma Health Workers (CHWs) active at the end of 2025, supported by 624 supervisors
28,755
BHWs targeted for 2030, with 1,438 supervisors
15%
Domestic share of financing targeted for 2035 (2026–2035 FSP)
3
Domains functional in 2025: governance, supply chain, service delivery
Main interventions and results
- System maturity: Diagnostic of the six foundational domains; overall score of 14 in 2024 (“good to excellent”), system “partially functional”; in 2025, leadership and governance and the supply chain became functional.
- Planning: Integrated community plans linked to the HIV, tuberculosis, malaria and C19RM grants, to harmonize interventions across counties.
- Community health workforce: Integrated community workforce framework and harmonized pay scale being rolled out, to reduce disparities between partners.
- Sustainable financing: Partner and investment mapping (support concentrated in accessible counties, under-coverage of remote areas); 2026–2035 FSP.
- Coordination: Reactivation of national and regional community health platforms, with the Ministry of Health repositioned as lead.
Republic of Guinea-Bissau – ICHESS results and impact
In Guinea-Bissau, ICHESS conducted three targeted missions in 2025 to give the Ministry of Health its first consolidated evidence base on community health. The country now has a system maturity profile, an institutional diagnostic, a 2021–2025 investment mapping and a first geo-referenced CHW database. These tools pave the way for a national strategic framework and an investment case.
Key figures
3
Support missions in 2025 (January, June, October)
4
Analytical deliverables handed over to the Ministry of Health
2021–2025
Period covered by the investment mapping
1st
Geo-referenced CHW database in the country
Main interventions and results
- January 2025: maturity and capacity: Foundational elements inventory, community health system maturity profile and capacity diagnostic of the ministry unit in charge of community health.
- June 2025: investments: Data collection for the 2021–2025 investment mapping: sources, volumes, activities supported and implementation areas.
- October 2025: CHW mapping: Consolidated database of CHW distribution and density, showing coverage gaps in remote rural and island areas (Bijagós archipelago).
- Next steps: National strategic framework, formal coordination mechanism, coverage targets for areas more than 5 km from a health facility, then an investment case and FSP.