Role of the community

Overstretched health systems due to lack of personnel and increasing demands have led many to consider alternatives to standard health care models.

In the previous section, Kober and Van Damme stress the need to establish new models of ARV delivery based on the patient and communities in order to cope with the massive increase in demand. Experience from the International HIV/AIDS Alliance also highlights the important role of the community. Human resources for health exist in communities documents the role of community organisations in the provision of ARVs in Zambia and Burkina Faso. It argues that public health systems will struggle to duplicate the same levels of energy, drive and local accountability in community programmes. The authors call for communities to be incorporated into plans to expand access to ARV therapy in resource-limited settings.

It is not only HIV and AIDS services that have begun to use community resources. Non-clinical family planning services in Tanzania have also drawn on community based programmes. Community-based distribution in Tanzania: costs and impacts of alternative strategies to improve worker performance describes how the these programmes use community organisations, structures and institutions to promote the use of safe and simple contraceptive technologies.

Another study from Ethiopia, documented in Teaching mothers to provide home treatment of malaria in Tigray, Ethiopia: a randomised trial, finds mothers are able to take care of their sick children when taught and supplied with appropriate guidance and drugs for home medication. The authors call for more attention be given to what family and community-based efforts can achieve when properly designed and applied in an appropriate setting.

While the community can play a critical role in filling the gaps left by health worker shortages, it is essential that adequate training and remuneration are considered. What motivates lay volunteers in high burden but resource-limited tuberculosis control programmes? Perceptions from the Northern Cape province, South Africa finds that many participants volunteer in the hopes of gaining skills and finding paid work. The authors suggest that incentives such as gaining qualifications while volunteering might lead to a lower drop out rate.

Janowitz et al also suggest that paying community workers more can reduce the costs of programmes by improving the performance of the workers.