Implementation objectives for this ingredient:

A supportive environment for community engagement, participation and social accountability

Strong advocacy and communication platforms

Integration of service delivery by communities into national systems

The vision of the Global Strategy cannot be realized without the central role of local communities as agents of change, demanding and delivering the quality services to which they are entitled.

The Global Strategy calls for strong community engagement to “[harness] the power of partnerships and [strengthen] advocacy through coalitions at all levels.” Stakeholders include communities, the private sector, women’s groups, human rights defenders, trade unions, adolescent networks, faith-based organizations and national and international civil society organisations, among others.

Governments and partners can work together to strengthen community engagement and align around a common effort with a diverse but mutually reinforcing set of messages, processes, tools and tactics. Civil society groups and community members themselves can lead community engagement, participation and advocacy efforts. Media, including participatory citizen’s media, can complement this. Although often overlooked, adolescents and youth constitute a key group that can actively engage as agents of social change to contribute to more effective policies and programmes to promote their own health and well-being. The private sector can also contribute to advocacy efforts, for example to strengthen supply chains, while explicitly stating their interests and avoiding any conflicts therein.

The Global Strategy also calls for community participation in service delivery, where communities are active providers of services and not mere recipients. Communities can deliver quality services with great impact, but these services need to be integrated into national plans and systems.

3.1 A supportive environment for community engagement, participation and social accountability

With a multi-stakeholder country platform, governments and civil society organizations can work together to identify and support agents of change in communities. Engagement and participation efforts can also provide communities themselves with opportunities for decision-making, planning, budgeting and contributing to accountability mechanisms. Examples include:

  • identifying local individuals working on or supportive of RMNCAH issues
  • providing resources necessary to support community engagement and participation, including capacity building and ensuring those most affected are able to engage (youth and women’s groups should be prioritized for support)
  • supporting existing social movements within countries to share information and monitor and demand access to affordable, acceptable and good quality health and social services without discrimination
  • integrating civil society participation and social accountability into national accountability frameworks, allowing citizen-generated information to be part of the processes for monitoring, review and remedial action
  • publicly funding the tools and costs of civil society engagement, with dedicated budget lines for this in national budgets
  • building mechanisms for public participation, including taking advantage of technological platforms (e.g. mobile phones and social media) to facilitate community advancement of problem identification, prioritization and solutions
  • recognizing community groups, particularly those most affected and those often excluded, with an equal platform to other traditional stakeholders such as professional associations
  • institutionalising the monitoring and evaluation of community engagement with specific indicators.

3.2 Strong advocacy and communication platforms

There is a continuing need for advocacy on RMNCAH issues, especially identifying and supporting existing national, sub-national and community-based partnerships, coalitions and activists. National, sub-national and local advocacy and communication platforms can enable individuals and communities to enact change in behaviours. Demand-driven communication for development strategies, based on sound analyses of social and behavioural determinants, can be used to 1) promote preventive practices and uptake of services, especially among those most marginalized, and 2) challenge discrimination and harmful social norms and stereotypes (particularly by engaging community leaders).

Advocacy and communication platforms can also facilitate social and community mobilization to create momentum and garner support to address health needs, particularly when they are driven by communities and used to promote participation and dialogue between people and service providers. In this way, decision-makers can be linked to community realities, creating space for dialogue, discussion and planning for evidence-based interventions. Such platforms can also be used to disseminate information on accountability mechanisms e.g. complaints procedures within health systems, and to support coordination among civil society and sharing of lessons.

Mapping existing resources that support people-centred advocacy for RMNCAH can help identify gaps in capacity, investments, data and information. A plan with national (and sub-national, if warranted) targets and milestones for community-engagement, partnerships and advocacy efforts can then be prepared to address these. Communities and other partners can be engaged to publicly monitor progress on capacity building, investments and related outcomes resulting from partnerships and advocacy work at agreed intervals.

3.3 Integration of service delivery by communities into national systems

Recognition and integration of the services provided by communities (including “task-shifting” and individual local private providers) into national systems requires:

  • explicitly recognizing community provision of service delivery as a resource rather than as a “stop-gap” measure
  • integrating community service provision into national plans and strategies
  • implementing quality support, supervision and referral for community provided services to other parts of national systems (e.g. secondary and tertiary health facilities)
  • providing remuneration and financial support from national and sub-national budgets for community provided services
  • integrating community-based workers into national workforce strategies and providing training and career development pathways
  • strengthening the linkages between health facilities and communities, through the use of technology for improved long-term follow-up and increased involvement of community leaders and local organizations


An Inventory of Tools to Support Household and Community Based Programming for Child Survival, Growth and Development


The community response to Ebola in Lofa County, Liberia

Lofa County in northern Liberia shares porous borders with both Sierra Leone and Guinea. In March 2014, the first cases of Ebola Virus Disease (EVD) appeared in Lofa County; within several months the county registered 724 cases, including 451 deaths. Key challenges included the limited knowledge of Ebola dangers and prevention among community members which led to stigma, fear and resistance, as well as the limited involvement of local leaders in the initial phase of the response.

In Barkedu Town in Lofa County, working in partnership with local authorities, religious leaders started a resilient and creative community response in July 2014, devising measures to stem the epidemic:

  • The community set up an 18 member Ebola task force comprised of youth, women, and community leaders. They organized their own rapid response system, identifying the suspected cases, isolating families and individuals, quickly carrying out safe and dignified burials and dispelling rumors by going door to door and organizing community dialogues.
  • To facilitate negotiation of safe burials, 11 young trusted community members volunteered to be on the burial team.
  • The town opened an isolation center for EVD cases since health centers had been deserted by health care workers.
  • The community traced and monitored all newcomers. When in quarantine, the population patrolled the borders and restricted access.
  • Quarantined families were closely monitored and provided with the necessary support they needed (food and non-food items as well as psycho-social support).
  • Traditional leaders suspended all secret society ceremonies to avoid secret burials.
  • Religious leaders prepared specific sermons addressing questions and resistance.

Government and its partners aligned their responses with the community, encompassing multiple activities that enabled Lofa County to tackle the epidemic while creating momentum and buy-in from the community members at all levels, and setting a precedent for the rest of the response. This formal engagement with religious and traditional leaders was the first of its kind in Liberia’s EVD response and proved to be critical in the resolution of the crisis. With this community leadership and community-based approach, Lofa County contained the epidemic in September 2014, with no further cases seen beyond this date.

Source: UNICEF (June 2015) Communication for Development: Responding to Ebola in Liberia. Lofa County: Communities took the matter in their own hands.