Community ownership of public health production and work is a cornerstone of effective global health interventions. It ensures that health programs and any resulting public health goods are context-specific, equitable, and sustainable.

Community participation stands as a fundamental pillar in the realm of global health, serving to enhance the effectiveness, equity, and sustainability of health interventions. In an increasingly interconnected world, the need for context-specific health programs that resonate with local communities has never been more critical. By examining strategies such as capacity building, participatory decision-making, and technology integration, global public health stakeholders can contribute to true community participation, leading to significant improvements in health outcomes.

In oor the gears of the global health mechanism to move more smoothly between global public health practitioners, policy makers and the communities they serve to fully address health challenges through a comprehensive framework, the classic social determinants of health and health equity need to be taken into account¹. There is no community participation without health equity.

Communities must be at the centre of the public health agenda. This can be achieved, for example, by prioritizing research on pressing health challenges—such as infectious diseases, mental health conditions, cardiovascular diseases, and obesity, at the forefront of scientific inquiry. Practically, what this could look like should be that, beyond international intervention in health crises situations, members of these local communities in the global south should be technically and technologically capable of performing research on the most pressing health issues in their localities for which they have first-hand experience.

As the Wellcome Global Monitor Survey, which intends to highlight public perceptions of science, showed in 2018 and 2020, most people surveyed showed the tendency to trust science when science benefits people like them; in the global south, people felt that science did not benefit them as much as people in the global north².

When individuals and communities at the receiving end of various health challenges are involved in finding solutions to these problems, a sense of responsibility, ownership and shared control is established. This could be useful in future instances of public health emergencies. The trust that has been previously established will promote a smooth flow of information and resources through reliable channels spearheaded by the communities themselves. This approach holds the potential to be: 1) Cost effective because once resources have reached the communities, local management of the resources are often cheaper in the longer term, 2) It builds the capacity of the local communities to tackle similar health challenges which they may be bound to face in the future, 3) Since the expert personnel are already in the communities, there is very little lead time which results in more lives being saved when health emergencies become a time scramble.

In this time when countries like the USA are focusing internally and severing established Foreign AID links to receiving countries and organizations downstream, individuals and communities must look inwards, act locally, and impact lives radially from the centre outwards.

How can this be done? This can be accomplished through strategies like participatory decision-making, participatory monitoring, capacity building, the integration of technology and cultural sensitivity.

In brief;

1. Shared Decision-Making: Communities should have a voice in health program design and implementation.
2. Participatory Monitoring: Engaging communities in monitoring and evaluation enhances accountability and sustainability.
3. Cultural Sensitivity: Interventions must be tailored to local contexts and cultural norms to ensure acceptance and effectiveness.

To conclude, I would like to emphasize the value of trust in a fast-changing world. One thing we learned during high health system stress periods like the Covid-19 pandemic 5 years ago or the 2014 Ebola epidemic in West Africa is that it is nearly impossible for public health actors to support communities or act in the interest of affected populations in a low-trust environment. Many global health experts believe that the next pandemic will happen in a low-trust setting. How can we then mitigate this? Trust in health systems can only be ensured when fairness, openness, and integrity, in addition to steps taken to ensure that communities can trust the wider governing instruments that may be applied on a global, regional or community level³.  Perhaps, the most important is that we must ensure that we are giving these populations what they need and not what we think they need. Global health action might not always have the ability to transform the lives of citizens of the entire globe, but true community participation in global health affairs might just be the lever we have been looking for to move the world.

References

1. Nuuyoma V. Community Participation as an Integral Part of the Biological, Psychosocial, and Social Aspects of the Management of Diseases and Illnesses. In: IGI Global eBooks. ; 2022:27-42. 10.4018/978-1-6684-6496-0.ch002
2. Wellcome. Global Monitor. Accessed March 24, 2025. https://wellcome.org/reports/wellcome-global-monitor/2018
3. Kickbusch I, Kirton J. Health: A Political Choice – Building Resilience and Trust. (Kickbusch I, Kirton J, eds.). GT Media Group Ltd; 2024.

Photo credit © Artem Podrez