ReBUILD Consortium, COUNTDOWN Consortium and REACHOUT Consortium (2015) All Party Parliamentary Group on Africa: Community led health systems and the Ebola outbreak, Joint written evidence from ReBUILD, COUNTDOWN and REACHOUT
Close-to-community providers of health care (such as community health workers (CHWs)) live and work within their communities, visiting people in their homes and workplaces every day, they can have a vital role in informing realistic healthcare policies that deliver results at community level. However even when their health promotion and delivery activities are recognised, for example in some CHW initiatives, they are often working in sub-optimal circumstances and are poorly linked to, and managed by formal health programmes. This has led to a disconnect between healthcare policy and the workers delivering healthcare services directly to individuals, families, and communities. This disconnect has resulted in loss of motivation and problems with health worker retention and ultimately an additional disconnect between service users in the community and health facilities resulting in a decrease in service utilisation. In Ebola-affected countries this is exacerbated by poor infrastructure, inadequate skilled health workforce which was further depleted by loss of health care workers to the illness, health systems which were already struggling and unresponsive in a post-conflict context, and Ebola-stigma against front-line workers. The recent call for more of a focus on people centred health systems and the devastating effects of Ebola in West Africa have brought communities to the forefront of the attention of decision makers. This is to be welcomed. But we would like to see this translated into tangible changes in the way that health systems are conceptualised and supported. This requires better learning from the Ebola response, opportunities to strengthen the sharing of lessons across affected settings, greater acknowledgement of community action in health systems research, and health systems policy and financing which explicitly supports these hard working and often extremely courageous citizens.
This project is funded by the European Union.