Towards Sustainable Community-Based Systems for Infectious Disease and Disaster Response; Lessons from Local Initiatives in Four African Countries

Abstract

This paper explores the role of decentralised community-based care systems in achieving sustainable healthcare in resource-poor areas. Based on case studies from Sierra Leone, Madagascar, Uganda and Ethiopia, the paper argues that a community-based system of healthcare is more effective in the prevention, early diagnosis, and primary care in response to the zoonotic and infectious diseases associated with extreme weather events as well as their direct health impacts. Community-based systems of care have a more holistic view of the determinants of health and can integrate responses to health challenges, social wellbeing, ecological and economic viability. The case studies profiled in this paper reveal the importance of expanding notions of health to encompass the whole environment (physical and social, across time and space) in which people live, including the explicit recognition of ecological interests and their interconnections with health. While much work still needs to be done in defining and measuring successful community responses to health and other crises, we identify two potentially core criteria: the inclusion and integration of local knowledge in response planning and actions, and the involvement of researchers and practitioners, e.g., community-embedded health workers and NGO staff, as trusted key interlocuters in brokering knowledge and devising sustainable community systems of care.

A conservation organisation’s approach to COVID-19: Lessons learned from Madagascar

“…An analysis of the response to the 2018–2020 Ebola crisis in DRC suggested that the knowledge of local frontline health workers should have been incorporated and acted upon (Mayhew et al 2021 :1743). Experiences in Madagascar and several other African countries have indicated that a community-based system of healthcare is more effective in the prevention, early diagnosis and primary care in response to zoonotic and infectious diseases associated with extreme weather events (Maat et al 2021 :1–16). Similarly, BV’s response to the COVID-19 pandemic was heavily dependent upon local expertise and the involvement of trusted local actors.…”

“…Blue Ventures currently supports 83 CHWs and 17 community health centres (CSBs) in Madagascar ( Figure 1 ). This multi-sectoral approach has led to increased access to family planning and uptake of modern contraceptives in previously underserved communities (Robson et al 2017 :77–78), to the continued provision of healthcare in the aftermath of a devastating cyclone (Maat et al 2021 :8–9) and to improvements in income from fishing (Oliver et al 2015 :11–13).…”

Sustaining disaster aid in the onset of the COVID-19 pandemic

“…This has been shown elsewhere to have a positive impact on humanitarian response. [7][8][9] Participants reported increased communication and a strengthened sense of trust and collaboration between many partners during the ongoing pandemic, although in situations where trust was already strained, the pandemic may have heightened this gap. The localization agenda has been an ongoing source of debate in the humanitarian sector, 21,22 and some respondents viewed the COVID-19 crisis as a testbed for this, as has been seen elsewhere.…”

“…4,5 The COVID-19 pandemic was an unprecedented event, 6 and as such, there was no prior knowledge of the impact of COVID-19 on the humanitarian response. The few studies investigating the impact of other health epidemics, eg, Ebola and Cholera, on ongoing disaster aid indicated that ensuring local knowledge and key staff are involved in decisionmaking, [7][8][9] and having a capacity to readily adapt to changing situations 9 are factors that would support an effective humanitarian response.…”

Priorities of primary care in disaster medicine

“…Every level of health service function must have Emergency Preparedness, Resilience and Response (EPRR) plans including PC providers. Implementation of an EPRR plan may have to be amended to allow greater sustainability as demand continues and will merge into new patterns of working 10. Many EPRR plans have a short-term time frame to them, which has a longer term outlook primarily in terms of mental health 11.…”