Community Responsibility for Healthcare

During my PULSE assignment with Partners in Health/Inshuti Mu Buzima (PIH/IMB), I have been fortunate to work with the School Health Program.   This program started in 2018 as a pilot in 15 schools in Eastern Rwanda with the objective of combatting the increasing incidence of malaria in children.  The program has since expanded to also address nutrition and adolescent sexual health issues in the pilot schools.  The program works by training teachers to apply community health guidelines to meet student health needs.  For example, teachers manage students with fever after being trained on administration of the malaria rapid test, provision of malaria medication and basic treatment of non-malarial fever.  I believe the program has shown success (there are plans to scale the program up to more schools) because of the following:

  • There is support and collaboration from local leadership such as the Ministry of Health and the Ministry of Education
  • The program meets patients where they are everyday (school)
  • Teachers are incentivized to help their students in a real way that they could not help before

The School Health Program epitomizes communities taking responsibility for the health of their members.  Communities being responsible for healthcare is something I have seen throughout Rwanda.  This is demonstrated through the well researched use of Community Health Workers (CHWs) in every village.  Communities being responsible for their members healthcare is not as evident in the US.  I’m sure there are examples of good community healthcare in the US, but in my experience is that you (the individual) are responsible for your own healthcare in the US.  The US system works if you know how to navigate your own version of the healthcare system (primary provider, local hospital, etc.).  The US system does not work if you are not an expert at navigating your local version of the system.  I’d say the majority of us are not navigation experts.

The question I’ve been thinking about (no answers yet) is how do we enable communities in the US to take more responsibility for their members healthcare?  It is a loaded question since the definition of community in the US can be different than other countries.  It is hard because communities with the greatest healthcare needs often have the least resource.  It is difficult because a prime driver of the US healthcare system is profit.  I need to do my own research but would also like to hear from others in the US if they have examples of effective programs where the community takes responsibility for their members healthcare.  How do we enable the community to care for it’s members where they live and work?

I’d be remiss not to include this fantastic sunset taken in Akagera National Park just last week.


  1. Hi Steve, what a great post & question? I don’t have an answer but agree with you that not everyone is a navigation expert in healthcare here in the US. Such a great topic/question to bring back home & ask your network though! Good luck!! P.s. The sunset is beautiful !

  2. Great question, Steve… Who would be a better person to ask, than Dr Paul Farmer himself? He must have given this quite some thought – and in anycase, what an interesting discussion to have with him!
    Thanks for the amazing Akagera sunset !

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