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Community Systems & Responses

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Communities play a central role in strengthening responses to HIV, tuberculosis and malaria. They reach, educate and link people, including those who are neglected, marginalized or criminalized, to services along the entire prevention and treatment continuum. Support for community systems and responses is a key component of the Global Fund’s mission to accelerate the end of HIV, tuberculosis and malaria as epidemics. But we can do more. The Global Fund is investing in efforts to align community systems and responses with formal health systems to maximize impact and to build resilient and sustainable systems for health.

The role of community systems

Communities are not just users of services. They offer valuable experience, expertise and leadership in governance, implementation and oversight over Global Fund-supported programs. Communities expand the reach and uptake of services far beyond formal health facilities and empower people to advocate for their rights while holding governments accountable. Community organizations and networks have an indispensable role to play in improving equitable access to quality services and in contributing to comprehensive health care. Community responses are diverse, dynamic and highly contextual. They have a unique ability to:

  • Identify and quickly respond to people’s needs and concerns
  • Reach and mobilize people – including those who are most vulnerable and affected by HIV, TB and malaria
  • Effectively manage, deliver and scale up treatment, care and support services
  • Monitor access to appropriate services and ensure program quality
  • Advocate for an enabling environment and programming to reduce human rights and gender –related barriers to accessing services

Bringing TB awareness to the community

Health volunteer Lach Sam takes part in a TB refresher course at a local health center in Samrong, Cambodia. Being a TB patient herself does not stop Lach Sam from continuing to provide treatment to others in her community. She also seeks out new suspected cases and organizes gatherings to teach villagers about the disease and how to prevent it. Volunteers in each village help not only to improve access to TB health services, they also raise awareness and fight stigma, leading to excellent treatment outcomes. The volunteer training program is supported by the Global Fund and its partners.

Investing in community systems

Countries submitting funding requests to the Global Fund are encouraged to describe how community-based organizations will be involved in programs. Involvement should include delivering services and monitoring the quality and performance of the services provided. Wherever possible, the Global Fund aims to open new opportunities to support community-based organizations. That goal includes allowing implementers of Global Fund grants to fund small, unregistered organizations or collectives that serve key populations and other marginalized groups.

Countries have been able to seek funds for community systems strengthening since 2007. The Global Fund Strategy 2017-2022 now provides a stronger strategic focus on strengthening community systems and responses within disease-specific funding and as part of resilient and sustainable systems for health. Applicants for Global Fund grants should provide an assessment of the strengths and weaknesses of community systems that support specific community responses. They should also identify measures to address those weaknesses. In addition, applicants are encouraged to allocate funding to specific initiatives such as:

  • Community-based monitoring to improve accessibility, responsiveness and quality of services
  • Community-led advocacy
  • Social mobilization, building community linkages, collaboration and coordination between communities and other health actors
  • Institutional capacity building, planning and leadership development

These types of investments are critical to improving the impact of programs that serve key, vulnerable and excluded populations. Enabling communities to be involved in monitoring and advocacy enhances their ability to engage with service providers and decision makers to express their needs, and to ensure that services and activities are appropriately designed and delivered.

Theater as powerful tool to prevent HIV

Actors Vanessa (left) and Alex perform in a play about a girl who loses a dear friend to HIV. Among Garifuna populations living in Honduras, plays like these are a popular and effective way of communicating messages about sensitive topics such as HIV, and often generate heated discussions afterwards. “Audiences have been very accepting,” says Vanessa. “I can really feel the change among youth.” The Global Fund supports the organizing of these events, the distribution of condoms, as well as the training that enables actors to deliver HIV prevention messages as effectively as possible.

Support for community responses and systems

The Global Fund’s approach to community systems and responses acknowledges the complex nature of interactions that exist between communities and the formal health sector. The Global Fund also recognizes that community systems and responses remain under prioritized and under resourced and that more needs to be done to incorporate community systems and responses into national disease and community health plans in order to achieve better outcomes for HIV, tuberculosis and malaria while strengthening health security and leveraging broader health gains.

In order to ensure that its investments strengthen community systems and responses, the Global Fund is investing US$15 million in efforts to support civil society and community organizations to meaningfully engage in the Global Fund processes during the 2017-2019 period. Such efforts include: country dialogue, funding request development, grant-making and grant implementation. These funds are provided through the Global Fund’s Community, Rights and Gender Technical Assistance Program.

Neighbors helping neighbors in the fight against malaria

In northern Rwanda, Janviere, a community health worker, visits the home of her neighbor Mr Gashimba to demonstrate use of a bed net to protect him from malaria. Janviere is part of the government’s campaign to provide malaria prevention and treatment in even the most remote rural areas of the country. Elected by her fellow villagers, Janviere has received training through a program supported by the Global Fund, and through prevention education and other interventions is helping to bring better health to her fellow community members.

Published 15 April 2017

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