Strengthening community networks and local leadership to tackle health inequities
The COVID-19 pandemic has exacerbated longstanding health disparities, exposing the critical need for robust community engagement and local governance to build resilient health systems. Marginalized communities, including racial and ethnic minorities, low-income households, and vulnerable populations, have shouldered a disproportionate burden of the pandemic’s impacts.
However, the crisis has also presented an opportunity to develop innovative, community-driven approaches to improve health equity. The Community Network Engagement for Essential Healthcare and COVID-19 Responses through Trust (CONNECT) Initiative in Lao PDR serves as a powerful case study, demonstrating how effective engagement with local government and community members can drive sustainable change.
Empowering local governance for community health
Traditionally, health programming in Lao PDR has been viewed as the sole responsibility of the Ministry of Health (MoH), with limited engagement from other government sectors or community stakeholders. This siloed approach has contributed to persistent health inequities, especially in rural and ethnic minority communities.
However, the COVID-19 pandemic catalyzed a shift in this dynamic. The rapid response to the crisis highlighted the crucial role of local government, particularly provincial and district governors, in mobilizing communities and coordinating multisectoral action. Recognizing this opportunity, the CONNECT Initiative sought to build on existing governance structures and leverage intersectoral collaboration to strengthen community health.
“Awareness of entry points and existing structures to strengthen local governance for health through mutually beneficial intersectoral collaboration” was a key lesson from CONNECT’s development.
Through an iterative, adaptive process, the CONNECT team engaged the Ministry of Home Affairs (MoHA) as a critical partner alongside the MoH. The District Offices of Home Affairs (DoHA) were identified as a strategic entry point, as they hold a mandate to build the capacities of village authorities and execute their responsibilities under the national decentralization policy.
By aligning CONNECT with MoHA’s priorities and existing mechanisms, the initiative was able to secure buy-in and support from local government, while also reinforcing their role in community health. This mutually beneficial collaboration enabled CONNECT to navigate local power dynamics, leverage resources, and institutionalize the intervention within government structures for long-term sustainability.
Cultivating trust and community ownership
Alongside strengthening local governance, CONNECT placed a strong emphasis on building trust and fostering community ownership – a crucial foundation for effective, sustainable community engagement.
Rather than prescribing a top-down approach, the CONNECT team adopted an adaptive, ground-up methodology, drawing on observations, community feedback, and iterative cycles of hypothesis testing. This allowed the initiative to be responsive to local contexts and priorities, and to empower communities as active partners in designing and implementing solutions.
“Building good relationships and trust together with an adaptive, grounds-up approach for sustainability and scalability” was a key lesson from CONNECT’s development.
A cornerstone of the CONNECT approach was the community participatory planning workshops. These brought together village authorities, community members, and health providers in a non-hierarchical setting to collectively identify priorities, leverage local resources, and develop community-led action plans. By creating a safe space for open dialogue and shared decision-making, CONNECT was able to nurture trust, break down barriers between communities and the health system, and cultivate a sense of ownership over health issues.
Complementing the workshops, CONNECT invested in building the capacity of health providers to deliver respectful, culturally-responsive care. This two-way approach – empowering communities while also supporting health workers – was crucial for strengthening the relationship between providers and users, ultimately enhancing the uptake of essential health services.
Embedding equity and adaptability
Underpinning CONNECT’s community engagement approach was a strong commitment to health equity and adaptability. The initiative explicitly sought to identify and address the unique needs of vulnerable populations, such as ethnic minorities, the poor, pregnant women, children, and people with disabilities.
By incorporating equity considerations into its design, implementation, and monitoring and evaluation frameworks, CONNECT ensured that marginalized groups were meaningfully included and that the intervention was responsive to their priorities. This equity-focused lens extended to the selection of intervention sites, the composition of community workshops, the development of culturally-appropriate communication materials, and the disaggregation of data to track disparities.
Moreover, CONNECT’s modular structure and adaptive methodology allowed the initiative to be tailored to diverse local contexts. Rather than a one-size-fits-all approach, each implementation site followed a flexible process of observing community needs, testing hypotheses, and co-creating relevant solutions. This flexibility enabled CONNECT to build on existing community strengths and power structures, fostering buy-in and sustainability.
Lessons for scaling community engagement
The CONNECT Initiative in Lao PDR offers valuable insights for other communities and governments seeking to strengthen community engagement and local governance for health equity:
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Identify strategic entry points and leverage existing structures: Understand the local governance landscape and seek out mutually beneficial partnerships across sectors to institutionalize community engagement within government systems.
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Prioritize trust-building and community ownership: Adopt an adaptive, ground-up approach that empowers communities as active partners, creating safe spaces for dialogue and shared decision-making.
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Embed equity and adaptability: Intentionally address the needs of marginalized groups and build flexibility into the intervention design to ensure relevance and sustainability.
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Invest in multisectoral collaboration and capacity-building: Engage diverse stakeholders, including local government, health providers, community organizations, and academic institutions, and strengthen their skills in areas such as data analysis, community outreach, and culturally-responsive communication.
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Prioritize data, evaluation, and continuous learning: Develop robust monitoring and evaluation frameworks that capture both tangible and intangible changes, and use data to inform iterative improvements and advocate for policy change.
As the world grapples with the ongoing impacts of COVID-19, the lessons from Lao PDR’s CONNECT Initiative underscore the critical importance of community engagement and local governance for building resilient, equitable health systems. By empowering communities and strengthening collaboration between government, health providers, and civil society, we can tackle health disparities and ensure that no one is left behind.
To learn more about the CONNECT Initiative and its approach, visit the Joint Action for Water website.
