The development of frontline health care services based as close as possible to local communities is still very much present on the African continent. “It’s an approach that has long existed in French-speaking and West Africa, for example. Primary health care is provided at a very decentralised level, often with the mobilisation of local communities,” emphasises Ridde, whose work is currently focussed on Mali, Burkina Faso and Senegal.
Former healers, teachers, or other trusted members of the community in villages and neighborhoods are mobilized and trained to become community health workers. They work on a voluntary basis, or for a small fee. They are not health workers in the strictest sense, but the shortage of health professionals in Africa means the call for community health workers is growing. “International organizations and donors often lend support to community health worker programs in villages, but it is very rarely lasting,” adds Ridde.
And yet, not only in West Africa but also in anglophone countries like South Africa, Kenya, Rwanda, and Liberia, community workers are often vital links in the public health chain, particularly in the fight against epidemics, precisely thanks to the fact that they are in direct contact with the local community. They are trained to recognize symptoms, to provide information on treatment, and can also become channels for broadcasting prevention campaigns.
“The World Health Organization began promoting community health worker programmes when it saw that we were going to be short of medical and health staff in Africa. We need to think carefully about who else could help in the fight against diseases like HIV and malaria.”
The Ebola epidemics of recent years have also been decisive in the scaling up of these programmes. “Liberia, for example, is a relatively poor country and its investment in the health system is low, but the community health system has been strengthened by Ebola, because the country had no other choice. And when Covid-19 arrived, Liberia was in a position to react. It now has a network of community health workers who know the situation on the ground and know where resources would be best placed,” says Manzi.
The community health workers are able to report back on the epidemiological situation in a particular village or region of a country. But is this enough to ensure genuine citizen participation in public health policy? “There is a basic problem of lack of knowledge and training to begin with,” says Ridde. “Most of the people in positions of power and decision-making posts in the field of public health, be it in West Africa or France, are overwhelmingly doctors trained in epidemiological and statistical public health. Community and participatory approaches are not sufficiently taught and are often denigrated.”
In Rwanda, community health workers operating as male-female pairs, “report to the local health centre on the situation in their village, and from there the information goes to the district hospital and then from there to the Health Ministry,” explains Manzi. “I think this is the aspect that needs to be strengthened in many countries. If Health Ministry teams could listen more to the voices of community health workers, many things might change.”
This story has been translated from French.
Rachel Knaebel is an independent journalist based in Berlin. She mainly covers social, environmental and political news in Germany for French-language press and online media.