Community Platforms for Public Health Interventions

4 December 2017

Greek mathematician, Archimedes said, “Give me a place to stand and I shall move the earth.” He was referring to his seminal work on the mathematics of the lever. Archimedes imagined that if he had a platform to stand on, and a big enough lever, he could indeed move the whole world.

A new paper applies Archimedes’ approach to global health by defining the characteristics of the platforms on which to implement public health interventions. Released in Disease Control Priorities 3rd Edition (DCP3), the paper defines the characteristics of community health platforms through which interventions can be launched in an effective and sustainable way.

The DCP series is one of the leading reference sources for detailed reviews on global health interventions and their cost effectiveness. Most chapters catalog interventions and estimate the disability adjusted life years and costs of delivering the interventions. Up till now, there has been little discussion of the platforms and levers on which to sustainably implement these interventions. Knowing that something is effective and cost-effective is not enough to make it happen.

The final volume of DCP launched on December 6, 2017 includes sections on health systems, financing and a chapter devoted to the community platforms that are required for successful implementation of public health interventions. The authors purposefully provide the how behind getting community-level buy-in and engagement in adopting the interventions that suit local priorities. The authors dissect the elements of successful community health platforms and illustrate these using case studies

Senior author David Bishai explained the need for change from the past and relatively current global health discourse, “Many think of global health policy making as a process of allocating funds to interventions from a catalog based on disease priorities. This has led to the carving up of global health into disease siloes and intervention siloes. Unfortunately, this approach puts power in the hands of the wise allocator and excludes the voice of the people whose health is at stake.”

Community health platforms are partnerships among public health professionals, politicians, and community members that rely on shared strengths to identify and develop responses to health concerns of the community. These partnerships build on the community’s own concerns and priorities as they are informed by the evidence brought in by the public health partners. They also link the community to its political officials in a conversation about health priorities. Ultimately the communities need to have information about the effectiveness and cost-effectiveness of interventions to address their priorities which makes most of the content of the Disease Control Priorities extremely valuable. In the long run, developing a functional community health platform is a self-sustaining way to ensure that the response to the local health burden is aligned with the strengths and vulnerabilities of the community. This type of response can outlast a series of externally imposed projects and initiatives.

“Factors such as engaging in real power sharing, building collaboration in partnerships, and enhancing cultural diversity within healthcare workers for intervention delivery all play a significant role in the likelihood that community engagement will result in improved health ” said co-author Melissa Sherry, a doctoral student at Johns Hopkins. The new research presents data from three case studies on real world community platforms at various stages of sophistication. One of the highlights is data on the Gerbangmas movement in Lumajang district in Indonesia which has continued to evolve across nearly two decades. In the community health platforms established in the Gerbangmas movement, the local health officers convened partnerships of NGOs and other sectors such as local schools to guide health strategy in partnership with the community. In Indonesia’s decentralized system, these partnerships proposed action plans and gathered the financing and resources to implement them.

The Executive Director of the World Health Organization’s Alliance for Health Policy and Systems Research, Dr Abdul Ghaffar summarizes the call-to-action, “When communities form alliances across sectors and engage health experts and politicians then policy officials will find themselves in a position with not only reduced costs, but also heightened community buy-in, engagement and sustainability.”