Transforming the Community Health Landscape: From Alma Ata to the Institutionalizing Community Health Conference
By: Nazo Kureshy, Community Health Team Leader, USAID and Jerome Pfaffmann Zambruni, Health Specialist / Child Health Unit, UNICEF
(Courtesy of Nazo Kureshy/USAID)
The Sustainable Development Goals (SDGs) are driving global efforts toward a “grand health convergence,” in which women and children in the poorest communities enjoy the same levels of access to quality health services as those in the wealthiest. We know that when communities are recognized as essential change agents for transforming health systems for women, children and adolescents, when communities are valued for their assets and resources and empowered, they can drive and sustain progress toward more equitable health outcomes and accelerate progress to end preventable child and maternal deaths.
We know, in fact, that approximately 2.4 million deaths of mothers and children could be averted each year if we strengthened and scaled up a package of evidence-based interventions focused on community-level volunteers, paid community health workers, and engaged communities.
Yet, health systems strengthening and existing initiatives have been slow to gain traction at the community level, and often work with communities primarily as targets or service recipients, rather than as empowered actors capable of playing a central role in making systems stronger and more equitable. Particularly in decentralized environments, implementation of national community health policies at scale remains a major challenge.
While evidence on the effectiveness of community engagement and empowerment for saving the lives of mothers, newborns and children continues to accumulate, we still have more to learn about how to build, sustain and scale vibrant community partnerships that are effectively integrated with health systems. This is critical for developing supportive policy and programming for community health and for documenting, replicating and scaling up successful approaches. Community health efforts are complex – using a range of appropriate methods to document what works and understanding why within and across countries is essential.
Are we ready to build stronger community health systems that drive progress toward achieving the SDGs, including the SDG 3 targets on ending preventable child and maternal deaths? Are we ready to follow in the footsteps of those few countries that have already built stronger community platforms and are now well on their way to ensuring their women and children have universal access to primary care? If the answer is yes, a meaningful focus on community must be at the heart of our efforts.
(Courtesy of Asselin/UNICEF)
This focus on community is not new, but the new vision for dynamic community health systems is a bold one. It recognizes and supports the roles of communities as valued and essential and empowered actors of the health system for:
- Delivering services
- Providing oversight for the delivery of health services at all levels
- Improving health literacy and advancing social norms that promote good health
- Enhancing the accountability of health systems to the people they serve
- Giving voice to those who are currently voiceless
Critically, this vision encompasses “softer” and all too often undervalued areas of action in community systems strengthening – inclusion, participation, trust, cohesion, agency and empowerment.
At the end of March, the Institutionalizing Community Health Conference (ICHC) will give us an opportunity to reflect on how to turn this vision for community health systems into a reality. We will take stock of our progress and of our unfinished agenda in community health. Together, we will explore pathways by which countries can strengthen their community health systems, reinforcing their overall health systems strengthening efforts.
The ICHC is a unique opportunity to assist countries in reflecting on current evidence and best practices, through a currently missing cross-cutting lens on community health systems, and with the leadership of 23 country delegations. (Country delegations consist of Ministry of Health, civil society, private sector, UNICEF, USAID, and WHO representatives. ICHC country delegations include the following countries: Bangladesh, Benin, Burkina Faso, Burundi, Cameroon, DRC, Ethiopia, Guinea, Haiti, India, Kenya, Liberia, Madagascar, Malawi, Mali, Mozambique, Niger, Nigeria, Rwanda, Senegal, Sierra Leone, Togo, and Uganda.)
Based on the lessons and experiences shared at ICHC, 23 country delegations will have the opportunity to refine their plans for short- and longer-term decisions, actions, and evidence needed at the national and local levels, with the aim of leveraging and building the capacity of community health systems as an integral part of health systems strengthening.
(Courtesy of Krzysiek/UNICEF)
Could more countries have achieved the Millennium Development Goals if community participation had been an integral part of the health system? Are we prepared to work differently in the SDG era, elevating community engagement as a priority area for action within the framework of the new Global Strategy for Women’s Children’s and Adolescents’ Health? Can we finally deliver on the promise of the Alma Ata declaration in 1978 to ensure access to primary health care for all?
2018 will see the 40th anniversary of the Alma Ata Conference. Though important successes have been achieved in increasing access to health, there is much work to be done. Years of vertical, horizontal, diagonal approaches to primary health care have not yet been successful in providing a fair chance for all women and children to thrive and transform their communities and societies. Are we ready to lead a paradigm shift in health systems thinking? Has the time finally come for building robust community health systems– supported by empowered and engaged communities – as a foundation of effective health systems?
We look forward to engaging together in lively debate as we seek new perspectives, wisdom, and insights. And we look forward to working with country delegations to position communities at the center of health systems, improving their capacity to lead the charge and end preventable child and maternal deaths.