For better health, let communities take the pulse and the purse strings

by Sophie Hares | @SophieHares | Thomson Reuters Foundation
Monday, 23 April 2018 10:28 GMT

A health worker injects a woman with an Ebola vaccine during a trial in Monrovia, February 2, 2015. REUTERS/James Giahyue

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Local participation and broad partnerships are crucial in fighting malaria and other diseases

Invariably, the people best placed to decide what help they need to stop their children catching malaria or to avoid another pregnancy are those confronted with the risks on a daily basis.

Yet much more needs to be done to hand control to communities who understand what would improve their own health and wellbeing, said speakers in a panel discussion on innovation in healthcare, hosted by Zilient.

"Community empowerment starts with giving people the capacity to draw down and build knowledge - we don't really have good infrastructure in place for that," said Paul Richards, author of “Ebola: How a People's Science Helped End an Epidemic”.

The Ebola outbreak that swept through Guinea, Liberia and Sierra Leone in 2014-2016, killing around 11,300, blindsided everyone, including governments and international aid agencies.

But local people quickly realised how the potentially fatal disease was being spread, and found home-grown ways to quarantine victims and cope with the devastating outbreak, said Richards, an anthropologist and university professor who has worked in West Africa for over 40 years.

Now that same momentum is being channelled to help communities in Sierra Leone improve sanitation and deal with malaria, which continues to dog them – for instance, by helping them identify different types of mosquito.

And given no two environments for the disease are the same, that local knowledge is invaluable, said Richards.


The World Health Organization (WHO) noted in its annual statistics report last year that globally, 10 measures of essential health service coverage had improved since 2000.

They include coverage of treatment for HIV and bed nets to prevent malaria, as well as access to antenatal care and improved sanitation.

But it's not all good news on the outcomes.

For example, the WHO warned late last year that global progress against malaria had stalled, with cases rising in 2016, and the vast majority of deaths occurring among babies and young children in sub-Saharan Africa.

With the Sustainable Development Goal of providing universal healthcare looming on the horizon for 2030, every cent of government and aid spending needs to be invested as efficiently as possible, said speakers.

Achieving that is an even tougher prospect in conflict-torn countries like Libya, where many doctors and nurses have fled the country – and international agencies are trying to fill the gap with limited resources and in insecure conditions.

Mouna Mayoufi, Libya health coordinator with the International Rescue Committee, said local healthcare centres were struggling with a lack of drugs, medicines and family planning, alongside administrative and economic problems such as high inflation.

IRC has mobile teams operating in the west of the country, providing care to both Libyans and migrants in the country, but Mayoufi said an emergency service like that needed to evolve into something more sustainable.

“Humanitarian interventions should focus on integration and transition to local authorities (in as many cases) as possible,” she told the Zilient webinar.

Globally, it is going to require hefty investments by governments and the private sector to make sure everyone has access to drugs and vaccines by the 2030 deadline, as well as functioning and equipped clinics and hospitals.

"We need to create more urgency, and remember that we need to continue to look at ways to be impactful and results driven - and we can't do it alone," said Monica Kerrigan, vice president for innovations at international health non-profit Jhpiego.


Teaming up with other organisations trying to reach the same people – whether with health services, clean energy or safe drinking water - would also ensure a bigger bang for every buck spent on improving the lives of some of the world's poorest, said speakers.

With a billion people dependent on clinics and hospitals that lack electricity for lighting, refrigerators or medical equipment, the roll-out of cheap solar power in many remote parts of Asia and Africa is having a dramatic effect.

And the knock-on health benefits of providing people with electricity in their homes are myriad, said William Brent, chief marketing officer at Power For All, which campaigns for universal energy access, with a focus on providing it through locally installed renewable sources.

“Tens of millions” of people in sub-Saharan Africa, South Asia and elsewhere have swapped kerosene lamps and stoves for lights and appliances powered by small-scale solar systems. “The air that they are breathing inside their homes is much healthier,” he said.

Solar pumps can provide clean water and help reduce disease, while boosting food production and nutrition.

Once people have access to electricity, they might then be able to buy smart phones, which opens up the chance of providing medical services remotely, Brent added.


Power to the people might be popular in theory - but unless aid organisations and governments are prepared to hand more financial control to those they want to support, communities will remain hamstrung, warned Richards.

There are plenty of ways to get money into communities and try to ensure it is spent on what it's intended for, he said, suggesting greater use of schemes such as vouchers.

Only by allowing villagers in Sierra Leone or Bangladesh - rather than an executive in New York or London - decide how the money should be used will more relevant and effective decisions be made, the speakers said.

"Place the purchasing power, place the initiative, place the planning back in the communities," said Richards.

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