Integrated Approaches to Health and Nutrition: Role of Communities

Despite considerable global progress against health-related Millennium Development Goals, gains made in different regions of the world have been uneven. 6.3 million deaths among children under age five, 289 thousand maternal deaths still occur each year, and 99% of these deaths occur in low- and middle-income countries (LMICs). Inadequate health systems and crippling human resource shortages pose serious bottlenecks to the achievement of health goals. Health system gaps disproportionately impact poor, marginalized populations, in both rural and urban contexts. Compounding major health system gaps, demand-side barriers have been shown to prevent or discourage individuals from seeking care even when adequate health services exist. Religious, cultural and social norms may preclude health-promoting behaviours. Poor and vulnerable populations are less likely to enjoy access to health-related information, challenging their ability to make informed decisions about when, where and how to seek care. Costs, including treatment, transportation and opportunity cost, also represent significant obstacles to seeking care. Both supply and demand-side gaps are impeding progress in achieving good health in societies. For decades, lay health workers and communities have stepped into fill these gaps. The global Sustainable Development Goals (SDGs) adopted in 2015 has shifted the focus from disease-specific interventions and poverty in LMICs to addressing issues of sustainability, human rights, social inclusion and justice and ensuring “no one is left behind”. Governments worldwide have rightly adopted sector-specific approaches to addressing problems with proven solutions. While interventions were aimed at communities in the past, governments are now increasing public welfare and domestic transfers to individuals. How these transfers, local programmes and public welfare platforms can be best leveraged to achieve good health and overall development pose interesting questions and debates on existing and future models of governance. Physical and virtual communities will need to be leveraged in the most optimal way.