My years of experience across the healthcare systems of our continent have taught me that transformation does not typically begin in boardrooms or policy papers. The most significant drivers of change are often the experiences of individuals on the front lines, the nurse in a rural clinic, the community health worker grappling with daily systemic barriers, etc. It is in their realities that the true impetus for revolution in healthcare takes root.
Think about some of the more remote parts of Nigeria, maybe up north where communities are spread out or even nomadic. You might find a fairly equipped primary healthcare centre there, a big investment by different groups. But then, days could go by with hardly anyone coming in. The thing is, the traditional way of life and how people move around mean that a building stuck in one place, no matter how good it is, just isn’t reaching them. It makes you see that even the most important infrastructure, like healthcare facilities, doesn’t mean much if it doesn’t fit with how people actually live and their culture.
“This realisation hits home: if healthcare is not deeply rooted in the community, we’re missing the mark when it comes to real change.”
This realisation hits home: if healthcare is not deeply rooted in the community, we’re missing the mark when it comes to real change. It means we’ve got to totally rethink how we set up and provide care so it actually reaches everyone who needs it.
Central to this reimagining is the empowerment of community health workers. These individuals, within their communities, understand local dynamics, cultural nuances, and health needs. They are key to moving beyond a static, facility-bound model towards a responsive, community-anchored approach.
Acknowledging their value is only the first step. The challenge lies in securing sustainable financing mechanisms for their continued operation. This is a critical aspect of healthcare transformation.
Enacting meaningful change from within existing healthcare structures often involves a strategy built upon government partnership, innovative financing mechanisms, and system-wide integration.
Read also: Healthcare in rural Africa: A crisis demanding collective action
Government partnership
Getting governments directly involved is critical to tap into and make the most of the resources they already have. This kind of engagement, in turn, helps communities feel like they own these initiatives. When we make sure our efforts line up with the country’s health plans and work closely with the ministries, community health programmes don’t feel like add-ons; they become a part of making the whole system stronger. And that collaborative spirit builds trust and streamlines policy.
Innovative financing
Recognising the constraints of conventional funding, a critical strategy for sustainable healthcare involves developing financing mechanisms that are deeply rooted in local contexts. Models like community-based savings and loan associations for health workers can empower frontline providers and ensure the ongoing delivery of essential services. This approach aims to move away from dependence on external assistance and cultivate local ownership of healthcare initiatives.
System-wide integration
True and lasting transformation demands a holistic perspective. We understand that community health initiatives cannot, and should not, exist in isolation. Therefore, FAH actively works across diverse government departments and ministries, ensuring that these vital community-level programmes are seamlessly integrated into broader healthcare systems. This inter-ministerial collaboration fosters synergy, avoids the costly trap of duplicated efforts, and ensures that community-level interventions are aligned with national health policies and clear referral pathways. Weaving this cohesive fabric of care, stretching from the heart of our communities to the highest levels of our health systems, we strengthen the overall resilience and effectiveness for everyone.
As we look ahead, the urgency to build resilient and climate-adaptive health systems becomes ever more critical. These systems must possess the inherent strength to withstand unforeseen crises while steadfastly continuing to serve our most vulnerable populations. Achieving this demands more than just clever financial engineering; it requires a fundamental reimagining of how we deliver care, prioritising genuine community engagement and fostering local ownership at every level.
The impactful work we’ve witnessed across nations like Nigeria, Kenya, the Central African Republic, Zambia, Senegal, Sierra Leone, Mali, and Ethiopia stands as a powerful testament to the transformative potential that ignites when innovative financing converges with strong government partnerships and authentic community engagement. These experiences are not only case studies; they are living proof that sustainable healthcare transformation is not a distant dream but an achievable reality within our grasp.
The enduring lesson from this challenging yet profoundly rewarding journey is clear – the most profound and lasting solutions often emerge from within the system itself. Embracing true collaboration with our governments, by empowering the invaluable contributions of our community health workers and by fostering innovative financing mechanisms that are rooted in local realities, we can collectively forge a future where equitable and accessible healthcare is not just an aspiration but a tangible right for all. The power to transform our health systems from within isn’t just a possibility; it is our shared imperative.
Ota Akhigbe is a seasoned leader in African health and development and a regular contributor to BusinessDay. Ota believes that true and lasting transformation within our healthcare systems is an inside job.
