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This op-ed was originally published in The Hill.

Along with the Ebola outbreak that’s already infected more than 1,600 people, the Democratic Republic of the Congo (DRC) is fighting another battle: An epidemic of fear and mistrust. Community members are afraid to seek treatment, including a promising experimental vaccine.

In the spirit of the 3,500-year-old Tao (Way) of Leadership, MSH works closely with local institutions and communities to create lasting and sustainable changes; changes that improve the health of people among the world’s poorest and most vulnerable groups.

And as the Tao indicates, sustainability starts with ownership, “The people will say, we have done it ourselves.”

Women in Kakamega County, Kenya are taking charge of their pregnancies, supporting their peers, and learning about healthy practices and self-care from skilled health providers. MSH’s Lea Mimba (“Take care of your pregnancy”) project, funded by UK Aid through the County Innovation Challenge Fund (CICF), tested an innovative group model for antenatal care (ANC) that responds to the needs and perspectives of women and front-line health providers. At six Kenyan health facilities, Lea Mimba provides a forum where pregnant women share experiences, learn birth planning and self-care practices, provide each other with emotional and social support, and receive essential health information from a skilled health provider, who is usually a nurse.

This article was originally published by Global Health Now.

Paid or volunteer?

Community health workers are on the frontlines in many countries—and vital to achieving universal health coverage. Yet the public health community has not reached a consensus on which model is the best.

Consensus is urgently needed, both at the global and country levels, to inform future policies and strategies for strengthening health systems and delivering on UHC.

Based on our experiences in rural Peru and Ethiopia, it’s not either-or. It’s both.

Full-time, paid CHWs form the backbone of family- and community-based services, but there aren’t enough to reach all families. We envision teams of government-paid, full-time CHWs providing comprehensive services to a given population, with a primary health center hub as the base of operations. Each CHW, in turn, would lead a team of part-time community health volunteers providing limited health education and referral services—such as maternal and newborn health, nutrition, hygiene, tuberculosis, malaria, and HIV/AIDS—to a small number of neighboring families.

The chart above shows the good-news-bad-news scenario that is the decades-long fight against TB in Afghanistan. TB is still a crushing problem there; the country has among the world’s highest rates of the disease, which killed some 10,000 people in 2017. But if you glance at this chart and think that we haven’t made much progress, look again. We’re finding and treating more people with TB in Afghanistan than ever before. In 2001, we were missing three quarters of presumptive TB patients — that is a whopping 75% gap in case detection.