The Importance of Community-Based Healthcare: HIV Advocacy in Sub-Saharan Africa

One of the most prevalent public health challenges affecting people worldwide today is HIV, human immunodeficiency virus. HIV remains a huge global health obstacle, specifically in Sub-Saharan Africa, where 67% of all 38.4 million people affected by HIV come from [1]. While HIV in Sub-Saharan Africa and the Global South continues to impact the overall quality of life in these regions, numerous measures are being taken to help improve HIV as a global health emergency. 

Specifically, a community-based approach has been taken. Community-based healthcare focuses on local prevention of a public health challenge, where community health workers, typically volunteers, provide medical services and education and administer prevention programs in specific areas. A 21-trial study found that 9 of the 21 trials reported that community health workers educated families and primary healthcare workers in countries like Kenya and Uganda on HIV treatment [2]. They were also responsible for training patients who were HIV-positive on the use of ARV (Antiretroviral therapy) treatment, so that they could easily administer it themselves or provide it to an individual who is HIV-positive in the future.

In addition, an early 2000s Uganda study conducted a community-based ARV program that was able to produce a 95% reduction in mortality of HIV-affected Ugandans, as well as an 81% reduction in mortality among the HIV-negative dependent children of said patients [3]. The program used community health workers trained for 4-6 weeks beforehand to deliver ARV treatment to patients’ homes, refer patients to clinics, and monitor adherence through regular community meetings. The Sub-Saharan African region receives significantly less care in comparison to other parts of the world; community-based healthcare and volunteer healthcare workers have made it possible for the region to receive the HIV treatment(s) it deserves.

On the other hand, critics of the community-based healthcare system and community health workers claim that the system does not adequately prepare its workers to deal with the true severity of HIV in Sub-Saharan Africa. Community health workers often lack sufficient funding to care for patients effectively and efficiently. Many are not provided with basic equipment like gloves, masks, and educational materials, do not receive sufficient training, and do not know enough about HIV and ARV treatments to help support HIV-positive patients [4]. While community health workers in susceptible regions do not receive the same resources as healthcare workers in the Global North (e.g., the US, Canada), critiques of community health workers are qualitative rather than quantitative. The “real” results show quantitative accomplishments, such as a Swaziland study that achieved a 71.4% decrease in HIV-related mortality solely through the Shiselweni Home-based Care (SHBC), a community home-based care establishment program [5].

Overall, the effect that HIV has in Sub-Saharan Africa is a global health challenge that remains unsolved. While the region will never fully recover from HIV’s effects on its population, community-based healthcare HIV-improvement measures are laudable. Without support from local Sub-Saharan African communities and volunteer healthcare workers, improvement would hardly have occurred. Community-based healthcare efforts should be applauded and implemented worldwide, as they are based on the principle of helping one another.

Designed by: Mira Jaafar Reviewed by: Sydney Yen

References 

[1] Moyo, Enos et al. “Key populations and Sub-Saharan Africa's HIV response.” Frontiers in public health vol. 11 1079990. 16 May. 2023, doi:10.3389/fpubh.2023.1079990.

[2] Mwai, Grace W., et al. "Role and outcomes of community health workers in HIV care in sub‐Saharan Africa: a systematic review." Journal of the International AIDS Society 16.1 (2013): 18586. 

[3] Mermin, Jonathan, et al. "Mortality in HIV-infected Ugandan adults receiving antiretroviral treatment and survival of their HIV-uninfected children: a prospective cohort study." The Lancet 371.9614 (2008): 752-759. 

[4] Ngcobo, Sanele, et al. "Roles, barriers, and recommendations for community health workers providing community-based HIV Care in Sub-Saharan Africa: a review." AIDS Patient Care and STDs 36.4 (2022): 130-144. 

[5] Abdullateef, Ridwanullah Olamide, et al. "Community health workers’ commitment to HIV/AIDS control in Africa." Journal of Medicine, Surgery, and Public Health 2 (2024): 100036.