Community minded: local investments for global health

Just over ten years ago, cases of Ebola were multiplying rapidly in West Africa. Suddenly, a virus that had previously been only a local issue quickly became global headline news, as it ravaged villages in Guinea and spread to neighboring countries Sierra Leone and Liberia. Eventually, it would reach 11 countries in total, including the U.S. and U.K., and cause more than 11,000 deaths.

While the Ebola outbreak of 2014 helped lead to a stronger focus on global health security, it also highlighted the power of community engagement. As the world watched, international aid organizations and local authorities scrambled to respond. What became clear was just how nuanced the response would need to be to reflect local culture and context, particularly in the rural areas being affected.

Evidence suggests that community involvement in the Ebola response was critical to success. Community engagement is now regarded as a key element of successful health programs, and further, an important tenet of a future with universal health coverage. Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, has called on ‘local leaders to unleash the power of communities to achieve irreversible change in Universal Health Coverage’.

On the heels of the 77th World Health Assembly (WHA77), held this year from 27 May to 1 June in Geneva Switzerland, it is plain to see why the theme of this year’s event is “All for Health, Health for All”. Achieving a disease-free world is a complex and multifactorial process, involving collaboration between a range of stakeholders in partnership with hard-hit communities. Community engagement and primary care are cornerstones of public health and can stop infectious diseases in their tracks. Ten years on from the Ebola outbreak and some six years out from the 2030 Sustainable Development Goal (SDG) deadline, it’s worth reflecting on what underpins their success.

Financial support is vital to building stronger, more resilient health systems capable of surveilling and responding to real time needs of communities, while also withstanding shocks in times of crisis. Investing in primary health care leads to more resilient health systems and is estimated to help achieve approximately 75% of the health targets in the SDGs; despite this, funding continues to fall short.

In December 2023, the landmark announcement of over US$777 million for neglected tropical diseases (NTDs) at the Reaching the Last Mile Forum in Dubai was a welcome show of commitment from international donors and country partners in a constrained fiscal environment for global health. We must now ensure that these funds are disbursed with the input of both the communities at risk and the community health workers who deliver essential services to ensure they meet the needs of the people they are meant to reach.

But money alone is not enough – time must be invested too. For decades, the humanitarian and global development sectors have waxed poetic about the “localization” agenda, shifting power and financing to the communities doing the work. The “Grand Bargain” agreed during the 2016 World Humanitarian Summit suggested 25% of humanitarian funding, for example, would be allocated to local and national responders by 2020. But a recent Devex report highlights that we have failed to translate this rhetoric into action in any meaningful way.

Change doesn’t happen overnight, and it must be sustainable. That’s why the Global Institute for Disease Elimination (GLIDE) seeks results that endure by respecting local context, capacities, knowledge, and leadership. All of this hinges on partnerships with communities, countries, and the frontline health workers who dedicate their lives to the health of others. These unsung heroes of global health ensure life-saving medicines and health interventions reach the arms and mouths of patients, including some of the world’s most vulnerable people who find themselves physically and metaphorically on the outskirts of society.

For wild polio, community health workers (CHWs) of the Global Polio Eradication Initiative are a shining example of the impact that community-led programming can achieve when proper investments are made. This corps of mostly women stands on the frontline of wild polio eradication efforts in the last two remaining countries where the disease persists – Pakistan and Afghanistan – and are key to consigning this disease to the history books. While we are not there yet, we are closer than we have ever been before. Their training and unique ability to earn the trust of the community allows them to react to other major health challenges, which they were forced to do to support the COVID-19 response and the subsequent vaccine roll-out.

Put simply, community health workers are the lynchpins of public health, keeping billions of people around the world healthy, and often working in the most difficult of circumstances. Yet somehow, they continue to be inexplicably undervalued and undercompensated, or even not paid at all. As we reconsider upholding of the “Grand Bargain,” we must ensure that this vital workforce is placed at the centre of national health systems, with a dedicated budget line.

We must identify, support, and engage these and other community ‘change-makers’, including community-led programs and local leaders. From the generosity of philanthropists to growing partnerships with the private sector, we have the ingredients for improving global public health and ridding the world of diseases like polio, malaria, and NTDs within the lifetime of today’s youngest children.

Communities can help keep their neighbours, fellow citizens, and other nations safe from deadly infectious diseases – but they can’t do it alone. The voices of those most affected must not only be heard, but listened to. And interventions must be country-specific and community-led.

Smart investment in communities is an investment in global health. The returns will be a safer and more prosperous world for everyone, everywhere, honouring WHA77’s pledge of ‘All for Health, Health for All’.