In responding to the challenge to have equitable, sustainable and effective health care services for all the citizens in the country, some African nations have decided on including the Community approach as part and parcel of National Health Systems Strengthening. These countries use a number of approaches which can be grouped under the title Community Health Strategy. The components of these community health approaches have the following in common. Firstly there is a unit (Directorate, Division, Department or Unit) at the Ministry of Health headquarter that provides policy guidance and over all coordination to working at the community level. Secondly there are designated personal to do the actual work with communities. These go by different names for example, Health Surveillance Assistants (HSAs) of Malawi, Health Extension workers (HEWs) of Ethiopia and or Community Health Extension workers (CHEWs) of Kenya. These workers are part of the health workforce and receive salaries from the Ministries of Health in their countries. Each worker is assigned to a particular population group that they serve. These cadres were with the selected individual from the community who may be designated as the Community Volunteer or the Community Health Worker or some other appropriate name. Thirdly, the people in the communities are themselves mobilised for active engagement in first line health care services as well as in health-promotion and disease-prevention. The introduction of the Community Approach is bringing about fast and sustainable positive changes in health and well-being. However, there are challenges in the approach. Among this is the fact that to have workers at the community levels solves the problem of access but comes with an increased wage bill. There is thus need for discussion how these challenges are to be met.