Towards sustainable community-based systems for infectious disease and disaster response; lessons from local initiatives in four African countries

Maat, Harro; Balabanova, Dina; Mokuwa, Esther; Richards, Paul; Mohan, Vik; Ssengooba, Freddie; Twinomuhangi, Revocatus; Woldie, Mirkuzie; Mayhew, Susannah


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.