In my recent trip to the Democratic Republic of Congo (DRC) I was reminded of an ingredient without which even the most well-designed health programs need to save lives – trust.
During my visit I met 17-month-old Marina at the Promesse health facility in Haut-Katanga Province. The little girl was clinging to her mother and waiting in line for her polio vaccine when I learned about her resilience. After a bout of malaria and several episodes of diarrhea, Marina’s mother, Vicky Tshibidi, brought the baby to Promesse.
The nurse in charge, Julie Kanjinga, prescribed a blood transfusion. When Nurse Julie also told Vicky that her daughter needed to be hospitalized, the mother dutifully followed her advice and returned home to pick up her daughter’s clothes for an overnight stay.
Community trust
Marina’s mother’s response made me reflect that people trust health care workers and systems that work for them. In a country where only one out of five children aged 12 to 23 months are fully vaccinated—and another 23% have received no vaccines at all1—we must build communities trust in a country’s health system to reduce the number of zero-dose and under-vaccinated children.
As countries experience a decline in donor health spending, governments and their partners must prioritize and invest in programs that go beyond output and deliver impact, starting at the community level. “Impact,” to the Promesse community, is not the number of children vaccinated or how many health care workers they encountered. It is about fewer cases of measles, illness and deaths occurring in the area. Impact is what they see and experience daily.
Yet even well-designed and well-intentioned, public health programs like vaccination cannot yield these life-saving results if the community does not trust health workers. A trusted health care worker is an asset. In our efforts to build responsive primary health care (PHC) systems that get health products and services to under-reached communities —VillageReach understands that there is no health care without health workers.
Dedicated health care workers
Dr. Ahmed Ogwell holds a child waiting to be seen by Nurse Julie Kanjinga at Promesse Health Facility, Haut Katanga, DRC.
After just an hour in Promesse, it is easy to see why community members like Vicky trust nurses and other health workers. When Marina first came to the facility, Nurse Julie noticed that the little girl was not only malnourished but had also missed several vaccines that other children her age had already received.
Malnutrition stresses and weakens a child’s immune system, making their bodies less capable of keeping infectious diseases at bay. With this understanding, Julie began visiting Vicky and her daughter at home to ensure the little girl was eating the right foods and returning to the facility to receive the vaccines she had missed. When the nurse could not make the visits, she would inquire about the mother’s and child’s well-being from the community health workers, known as relais communautaires (RECOs) in DRC. These are mostly volunteer frontline providers who conduct home visits and screenings and are often the main touch point under-reached communities have with the health system.
Nurse Julie’s dedication and her coordination with the RECOs sparked made me realize that even with limited resources, health workers often go beyond their formal duties to ensure community members receive care. These health workers have carried vaccines in cool boxes to marketplaces and other community gatherings, bringing vaccines to caregivers whose economic realities—like working for daily wages—conflict with routine vaccination schedules. The willingness of these health workers to do more with less is an important lesson for civil servants faced with a similar reality today.
Government ownership
Dr. Ahmed Ogwell meets with DRC Minister of Health Dr. Samuel Roger Kamba, Kinshasa, DRC. Photo Credit: Mbimba Luyeye Lie̕vin
The DRC government fosters the trust communities have in the health care system and the dedication of health care workers to focus on real impact. In a meeting with His Excellency, the DRC Minister of Health Dr. Samuel Roger Kamba, we discussed that even with limited resources, the government should champion the professionalization of RECOs, ensuring there is a smooth connection between the formal health care system and the community.
The government’s willingness to utilize what is already available—the trust and the RECOs—highlighted me that when governments take the lead and partners center their programs on government priorities, PHC systems become more responsive. As governments recommit to aligning with the Abuja declaration (committing at least 15% of their national annual budget to health), VillageReach supports them in ensuring those allocations are being used for their intended purpose – and are addressing the countries real health priorities. When governments lead, that is when real change becomes sustainable at the local level.
When I see the commitment of government officials and health workers to meet the needs of under-reached communities, I am humbled that VillageReach plays a role in DRC through our programs and innovations. Real results must be rooted in trust. The people I met on this trip inspired me that despite the challenges ahead to strengthen PHC, I know that together we can make an impact. We can make sure that every child like Marina has the health care needed to thrive.