To Provide Healthcare for All, Look to the Community
By Dr Zaeem Haq, Head of Technical — East and Southern Africa, Malaria Consortium
In 1978, the international community came together in Alma Ata (Almaty of today) to declare their commitment to protect and promote the health of all people. The Alma Ata Declaration identified primary healthcare as a key priority for achieving health for all. Countries such as Bangladesh and Ethiopia made tremendous progress by investing in primary healthcare and improved maternal and child survival dramatically. Prospects for health improved significantly owing to medical research, social development and international collaboration.
Having started my life in a low-income setting around the same time, I’m fortunate to have benefited significantly from this development. Yet 40 years on, the ambition ‘Health for All’ remains elusive and universal health coverage still an aspiration. Poor and vulnerable communities remain farthest behind, with millions lacking access to even basic health services.
According to the World Health Organization (WHO), over 15,000 children under-five die every day, mostly from preventable and treatable illnesses such as malaria, pneumonia and diarrhoea. Access to qualified health workers, facilities and hospitals is fairly limited, particularly for those living in rural remote communities. This is exacerbated by a global health worker shortage of over seven million, which is expected to nearly double by 2035.
Malaria Consortium has been working closely with governments and partners across Africa and Asia to help address these challenges to improve access to quality healthcare for disadvantaged populations. As outlined in our recent report, we believe strengthening community-based primary healthcare is the key to unlocking Health for All, and as such we’re contributing to strengthening national and local health systems, supporting frontline health worker capacity and quality of service delivery, improving community engagement and family practices, while generating learning and evidence to help strengthen national and global policies and practices.
We’re on the frontline of the fight for child survival across Africa and Asia, enabling over 30,000 community health workers (CHWs) to save children’s lives and deliver quality healthcare services. In Uganda, we’re supporting Village Health Teams in nearly 100 districts to improve access to maternal and child health services, and deliver preventive interventions such as mosquito nets. In Mozambique, our innovative digital health system is supporting CHWs to effectively manage and report common childhood illnesses.
Our pioneering operational research on improving pneumonia diagnostics in Ethiopia and Nepal will enable CHWs to better diagnose and manage childhood pneumonia, which is the leading cause of under-five death in most low-income settings. Our innovative approach on community dialogues has facilitated communities in Bangladesh, Mozambique, Uganda and Zambia to adopt healthy behaviours and practices, helping improve prevention and care-seeking for common childhood illnesses and neglected tropical diseases.
Despite the wealth of global evidence around the crucial role CHWs play in cost-effectively extending access to vital health services, tackling disease burdens, and having an impact on many of the Sustainable Development Goals (SDGs), they remain outliers of formal health systems in most countries and considered as unskilled volunteers in rural communities.
There is a need to integrate CHWs better within national health systems and provide them with similar recognition and reward mechanisms as other formal cadres of health workers. We believe the path to universal coverage involves governments taking increasing ownership of CHWs, committing domestic resources to integrate CHWs effectively to extend access to primary healthcare for all communities, as outlined in our recent brief on sustaining health services in low income settings.
As the international community mobilises towards realising the SDGs, it is clear that community based primary healthcare is the key to achieving universal health coverage, and skilled and supported CHWs the means by which we can effectively achieve health for all by 2030.
