Switching up the dial on community voices for UHC

‘Communities at the heart of UHC’ is a coalition of six organizations—Amref Health Africa, Aspen Management Partnership for Health, Financing Alliance for Health, the International Rescue Committee, Last Mile Health and Living Goods – which are leading an effort to elevate the visibility of community health within the UHC space.

It works with many other organizations, and is part of the larger movement, including UHC2030, donors and country leaders working to increase the dialogue on community health programmes globally and advocate for funding. UHC2030 spoke with Crystal Lander of Living Goods and Desta Lakew of Amref Health Africa to find out more.

Here’s what they had to say: 

How did this campaign come about? 

Crystal Lander: It was truly a great coming of minds together at the World Health Assembly last year where we sat together and had a conversation about the key things we felt were missing from the discussion on UHC. One of them was the lack of community voices. Front line health workers, community health workers, community nurses, service delivery providers - all of those people who work on a day-to-day basis – have valuable experiences and opinions. Yet, we rarely have a really substantive opportunity to hear those voices and for them to be part of the decision making process 

We want to make sure that as we lead up to this United Nations General Assembly High Level Meeting on UHC and then move beyond it, that community voices are seriously taken into account. 

Why does community health for UHC matter? 

Desta Lakew:  One of the things that we (Amref Health Africa) are really good at is connecting the last mile to first level care. Our perspective is really that if you have a strong integrated health care system, that incorporates community health workers as a meaningful and important part of transitioning to UHC, then you will actually be able to capture those who are left behind.

The beginning of a patient’s journey in Africa often starts with a community health worker. It is the CHW that drives patients to seek service; who ensures there is community outreach and education so people are empowered to care for themselves; and it is the incredible reach that CHW’s have that connects the last mile. This is a fundamental foundation on which to build UHC. 

The work that is done at community level helps identify the kinds and levels of services are needed and what the benefit package for UHC should look like if it is meant to cover the most vulnerable. How can you determine a benefit package if you don’t understand the community needs? It’s about looking at UHC from the perspective of the community’s needs with equity at the center of the equation. 

The idea is to switch up the dial on the community voice so that decisions that are being made today to reach UHC in 2030 are reached from the perspective of communities. 

How are you conducting the campaign?

Crystal: We want to use our networks and our voices as broader organizations to keep championing messages about communities for UHC at the top level. A number of Ministers of Health and political leaders at the country level are extremely passionate about the community aspect: they support it and care about it but there’s still not enough of them. So we want to use great spokespeople and champions - like the Ministers of Health in Ethiopia, Uganda and Liberia - to communicate with their peers and advocate more strongly for community voices in UHC decisions. 

We are also able to leverage UHC civil society mechanisms and UHC2030 to help do that. It’s everyone looking at the whole picture instead of individual health areas. 

Desta: This is primarily a social media campaign, but there are other key moments and milestones where we make sure this message is amplified. We launched the campaign at the Rockefeller Foundation in September 2018 in New York, and since then have been active at the Global Conference on Primary Health Care in Astana and the Africa Health Agenda International Conference in Kigali. 

We are amplifying community voices in these spaces, and also engaging Ministers of Health and other high-level political actors in the conversation. For example, in Kigali we organised a plenary ‘fireside chat’ between a community health worker from Ethiopia and the Minister of Health in Rwanda. 

That dialogue was really critical because the CHW said, “Look, in Ethiopia we have managed to push out a very strong community agenda with CHWs at the heart of health care delivery because Ethiopia as a country made a political commitment to integrate CHW’s into the formal health system and compensate them. Therefore, we are held accountable by the fact that we are salaried, which in most African countries is not the case; CHWs are volunteers. Why don’t other countries pay their CHWs so that they can be held accountable too and deliver results for UHC?” 

The majority of countries are actually serviced by CHWs. CHWs are also the ones who drive demand for services, and who link the last mile to first level care. So this conversation matters a great deal. 

It’s important that we see this campaign as also driving and empowering community-based organizations, grassroots or global NGOs to think global, but act local. This means to understand the global prerogative of UHC, but to encourage local actors to determine UHC policy and implementation in countries. When we engage communities, NGOs, policy makers, development partners, Ministries and parliamentarians we are recognizing that each component makes up the whole and that whole is what will lead us to UHC. 

Find out more about the campaign here. 

Follow Communities at the heart of UHC on Twitter @UHC4Communities