by Christoforos Mallouris, Regional Adviser Equality And Rights For All, UNAIDS Support Team for Eastern and Southern Africa
Communities of people living with or affected by HIV have been at the forefront of delivering HIV-related services since the beginning of the HIV epidemic. UNAIDS, under the 2gether 4 SRHR Programme, recently launched a publication highlighting the significant role of community-led and community-based service delivery in shaping the HIV response and influencing broader health outcomes with far-reaching success. These grassroots initiatives are people-centred, addressing the holistic needs of individuals, and they are reaching the most vulnerable. As a result, they are transforming healthcare systems and changing lives in lasting ways that go beyond HIV.
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Community-led and community-based systems are showing us how healthcare should be delivered. Here are five of the most compelling ways:
1. Tackling mental health and trauma in the community
Mental health support is often overlooked in formal health systems, but community-led organisations are stepping in to fill the gap. Groups like Dlalanathi in South Africa use child-centred play therapy to support grieving children. The group also hosts family support groups focused on sexual and reproductive health rights (SRHR) and SRHR youth dialogues. Ishtar MSM in Kenya and Tranz Network Uganda (TNU) provide HIV care and prevention in addition to psychosocial care for LGBTQI individuals and sex workers facing trauma, stigma, and substance use. These services are not just healing individuals; they are strengthening families and entire communities.
2. Bringing healthcare home with mobile clinics and peer workers
Organisations are innovating how healthcare is delivered with home-based care, mobile clinics and mentor mothers. Mentor Mothers are trained community health workers, often women living with HIV, who provide support, education and health and HIV-related guidance to pregnant women, new mothers and families. Philani in South Africa trains “mentor mothers” to deliver maternal and child health services directly to households. Meanwhile, Ahitipaluxene in Mozambique provides volunteer-based home care; and TASO in Uganda reached over 20,000 people with HIV services using peer outreach. Healthcare is meeting people where they are.
3. Bridging health and economic empowerment
Community-led initiatives recognise that poverty is a barrier to accessing healthcare. As a result, they often offer economic empowerment. In Kenya, WOFAK supports women with microcredit loans. The organisation also provides a wide range of community-based health, education and psychosocial support including HIV counselling and testing. In Zambia, Kwasha Mukwenu runs a skills training centre for women and youth. In Namibia, TOV is turning eggs, chickens, and fish into income streams that support children’s education. Yes, health is about money too.
4. Fighting stigma and advancing rights
Dignity and inclusion are essential to delivering quality health care. That’s why organisations like Rainbow Mirrors Uganda and Ishtar MSM are advocating for the rights of marginalised groups. They are creating safe spaces for LGBTQI individuals, challenging criminalisation laws and leading public education campaigns. These groups go well beyond just providing services, they are redefining what inclusive, rights-based healthcare looks like.
5. Creating holistic, people-centred support systems
The real power and strength of community-led models is in their flexibility. These organisations respond to what people need. They work holistically, providing a range of services from education and housing to gender-based violence prevention and child protection. For example, Uganda Young Positives offers everything from peer support groups to entrepreneurship training for HIV-positive youth. Their work shows that true health means supporting the whole person.
Community-led and community-based health systems are setting new standards for the way healthcare should be delivered: people-centred and holistic. As global health challenges grow more complex, if we want greater impact and better health outcomes, healthcare starts with and in the community.
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2gether 4 SRHR is a joint UN Regional Programme, in partnership with Sweden, which brings together the combined efforts of UNAIDS, UNFPA, UNICEF and WHO to improve the sexual and reproductive health rights (SRHR) of all people in Eastern and Southern Africa. For a one-stop shop of information and resources in Africa, visit the SRHR Knowledge Hub.
The views and opinions expressed in this opinion piece are those of the author, who is not employed by Health-e News. Health-e News is committed to presenting diverse perspectives to enrich public discourse on health-related issues.
