Go to the people. Live with them. Learn from them. Love them. Start with what they know. Build with what they have. But with the best leaders, when the work is done, the task accomplished, the people will say, ‘We have done this ourselves’
Close to two years after the first Covid-19 case was reported in China the pandemic has been rated among the 10 deadliest plagues in history, having infected over 213 million people and causing the deaths of nearly 4.5 million people around the world.
The pandemic stands at the top of the growing list of public health emergencies that require massive cooperation and coordination at all levels, from high-level policymakers and political heads to community leaders and grassroots mobilisers.
Historically, widespread health interventions have often failed to involve the communities they are meant to serve.
Designers of health policies and solutions focus largely on what they consider most important – such as financing and systems – while forgetting that at the core of any successful health intervention is community ownership.
As health challenges evolve so should our approach to delivering sustainable interventions. With the number of people in need of humanitarian assistance rising from 78 million to 235 million between 2015 and 2021, engaging communities to meet health and development targets must be seen as an urgent priority.
Health interventions need to be contextually relevant. For communities to take full ownership of the solutions presented to them and participate in interventions being delivered, they need to be at the centre of the design and delivery process.
Lao Tzu, the ancient Chinese philosopher, once said: “Go to the people. Live with them. Learn from them. Love them. Start with what they know. Build with what they have. But with the best leaders, when the work is done, the task accomplished, the people will say, 'We have done this ourselves’.”
Enabling communities to determine and improve their health outcomes is the surest way to guarantee that solutions proposed are culturally relevant, effective and sustainable.
Conversely, exclusion of community members in design and implementation of health interventions leads to solutions anchored on presumed needs, which neither reflect the lived realities nor meet the health needs of targeted populations – leaving vulnerable groups even further behind.
Continued colonisation of global health has resulted in African populations bearing the brunt of health interventions imposed on us as a result of glaring gaps in the understanding of our numerous cultures, traditions, and norms, which have typically been viewed as barriers to “modern” health development.
Prevailing attitudes and hesitancy towards science-backed Covid-19 mitigation measures, for example, are a clear indication of what happens when health professionals – no matter how pure their intentions – fail to consider the nuances of culture when responding to health crises.
Seeking to understand cultural nuances can enable health professionals to work closely with communities to increase participation in health interventions, be they focused on widespread disease outbreaks or addressing other health issues such as maternal health.
For instance, in Kenya, use of the traditional birthing cushion is helping reduce maternal and child mortality, while investment in community health strategies is empowering community health workers in Ethiopia, which stands out as an exemplar country for its successful approach to delivering primary health care interventions.
Both these examples illustrate how working with locals in culturally sensitive contexts can drive much-needed change in social behaviour and improve health outcomes on the continent.
Much of this success will also require the strategic use of communication and advocacy to deepen the impact of health interventions.
Throughout history, storytelling has played an important role in spotlighting development work. Whereas it has often been used to drive stereotypical narratives told through the lens of the “saviour”, we have an opportunity to promote ethical storytelling that empowers local communities to shape their health outcomes and equips them with the tools to tell their own stories, therefore positioning them as the champions of their own narratives.
Media can be localised and used to inspire trust and create meaningful engagement driven by beneficiaries of health interventions, making them an integral part of health response especially when utilised with empathy.
So, as we strive to respond to Africa’s most pressing health challenges, let us remember that deeper community engagement and empowerment are needed to accelerate achievement of better health outcomes for lasting health change.