From 19 to 22 April, 2021, UNICEF and USAID, in collaboration with the Bill and Melinda Gates Foundation, the Community Health Roadmap and the Community Health Community of Practice (CH-CoP)  convened a second Institutionalizing Community Health Conference (ICHC 2021) to take stock of and build on experiences and knowledge since ICHC 2017. This virtual event gathered 2000 experts. A special plenary storytelling session was designed to highlight the stories of women leaders in community health and the impact of their leadership in Liberia and Zambia. This blog summarizes the narratives about their experiences in community health work. 

by Nandini Oomman, Kathryn Conn, Nazo Kureshy, Rachel Deussom, Iris Mwanza and Maureen Kerubo Momanyi

In a world where primary health care is delivered by women but led by men, female voices are too often silenced, interrupted, or just ignored. The Institutionalizing Community Health Conference 2021 (ICHC) shone a spotlight on the passion and power women leaders bring to the visioning and implementation of reforms that institutionalize the role of communities and primary health care systems to achieve universal health coverage. With USAID support, the Human Resources for Health 2030 project and The Women’s Storytelling Salon collaborated with the ICHC core team^[1] to host a session on “Passion & Purpose: Stories of Women’s Leadership in Community Health.”

Dr. Bernice Dahn from Liberia and Dr. Sylvia Chila from Zambia shared highlights from their personal journeys to illustrate how they grew into community health advocates; brought diverse stakeholders together; and used their power and influence to solve complex systems challenges, including the COVID-19 response. Dr. Bernice Dahn is the Vice President/Executive Dean for Health Sciences at the University of Liberia. As the Minister of Health and Deputy Minister of Health and Chief Medical Officer for the Republic of Liberia, she developed Liberia’s health sector recovery plan and health workforce program, recognizing the critical role of health workers – especially community health workers – in ending the Ebola crisis. Dr. Sylvia Chila, Assistant Director, Community Health, Ministry of Health in Zambia, pioneered important health reforms including community involvement in safe motherhood programmes, Tuberculosis and HIV Management.

The storytelling plenary session recognized these leaders’ achievements and the impact they have in challenging cultural and political contexts. By building a shared understanding of the human experience of women’s leadership, the session offered a unique space at the ICHC 2021 to create a cohesive community of community health stakeholders from over 80 countries with diverse priorities, experiences, and perspectives.

What did we learn from this storytelling session?

1. Applying learnings from other country experiences can accelerate community health and primary health care (PHC) in home countries.

Fortunate to have had educational and professional experiences outside their home countries on scholarships and fellowships, these women leaders described how these opportunities transformed their careers in community health.

Dr. Chila left Zambia to study medicine in Cuba, receiving her MD from the Institute of Medical Sciences in Santiago de Cuba. While learning Spanish and living in a “different world”, she observed Cuba’s primary health care model: community-based clinics staffed by a local doctor and nurse. Dr. Chila was inspired:

“[I] looked at the system that worked so well and the only thing I wanted to do was finish my training and come and do the same thing for my country.”

Dr. Dahn studied medicine during the war when many professors left, but she persevered to complete her degree. She later traveled from Liberia to pursue a master’s of public health fellowship at the University of Washington in the US. While Dr. Dahn had already worked for several years as a physician with the Ministry of Public Health in Liberia, her educational experience transformed how she would approach her work in the future:

Key Takeaway: Invest in opportunities for women’s education and leadership in global health because women are invested in health.  They effectively use the knowledge and skills they gain from these experiences to strengthen health systems and improve outcomes.    

2. Women leaders engage diverse stakeholders to create policy and program shifts.

When Dr. Dahn became the Deputy Minister of Health & Chief Medical Officer, in a post-war Liberia, she realized early on that stakeholder collaboration was essential for (re)building community health systems. Her team  “had to build the whole healthcare delivery system from scratch.” This required a shift from NGO-controlled resources to government ownership of the development agenda that would include community health as part of the basic package of health services. Dr. Dahn needed buy-in from both international and domestic stakeholders and brought all of them, including government, NGOs, consultants, and technical support to the same table. In collaboration with 19 donors and partners, she established coordinating committees, developed a national health policy and strategy, and ensured technical and financial support to implement that strategy.

Key takeaway:  Recognize women’s leadership skills that leverage partnerships and coordinate actions from the community level to the national level to galvanize joint efforts and increase domestic and external investments for community health systems.

3. Despite gender constraints, women leaders use their power and influence to overcome complex systems challenges and respond to health emergencies.

Both Dr. Dahn and Dr. Chila have had successes in dealing with their countries’ complex health systems. In Liberia, the government’s learning from its experience with Ebola outbreaks, helped the country in its COVID-19 response. During the Ebola crisis, Dr. Dahn emphasized the critical role of health workers, especially community health workers (CHWs), in ending the crisis and set up a process to mobilize the community health workforce. In the aftermath of the crisis, Dr. Dahn provided the leadership to develop Liberia’s Health Sector Investment and Recovery Plan including a Health Workforce Program for workers at all levels. In Zambia, in response to improving access to family planning, Dr. Chila–as a district director of health in a mining town in Zambia-was strategic not only to involve men and adolescents in the safe motherhood and adolescent health programs, but also to design an outreach program to bring services directly to the community. She later led the refinements and costing of the Zambian community health strategy, pioneered health reforms, and worked on tuberculosis (TB)/HIV programs in Botswana, including multi-drug resistant TB.