As preventative health features prominently in the government’s agenda and in particular as a focus for improving the NHS, I’m continually on the lookout for the easy wins and the low-hanging fruit that build and embed health into our local communities.
Often these are initiatives that improve individual and community health in local areas by
· recognising and bolstering social determinants of health
· raising awareness of health challenges and opportunities
· fostering and sustaining dialogue amongst community members
· providing education and supporting behaviour change
One proponent of this approach is Lord Nigel Crisp, former Chief Executive of the English NHS and Permanent Secretary of the UK Department of Health from 2000-2006.
Over the last several years, he led a campaign to raise awareness about the role housing plays in our individual and collective health by sponsoring the Healthy Homes Bill. He also wrote a book about community-led health, aptly titled
“Health begins at home, hospitals are for repairs”.
Interestingly this phrase was adopted from his work in Uganda where he continues to be involved through the UK-Uganda Health Alliance. Nigel explains how he got involved here:
“I began working in several African countries when I left the NHS in 2006, and I quickly discovered that our respective health systems have a lot to learn from each other. We must abandon the top-down idea of international development and replace it with co-development.
I met African health workers without our resources – and, crucially, without our historical baggage and vested interests – who were developing innovative approaches to health. Crucially, I witnessed the major role that communities can play, not just in healthcare but in creating health. As Professor Francis Omaswa, formerly head of the Ugandan health service, told me: ‘Health is made at home, hospitals are for repairs.”
And so this was very much on my mind while I was in Uganda last week, supporting the extraordinary NGO Brass for Africa where I’m a trustee.
Visiting multiple outreach projects in Kampala and beyond demonstrated to me how giving young people opportunities to participate in a music and life skills programme delivers impact in multiple ways.
These programmes also serve as powerful vehicles to improve individual and community health, and three in particular struck me in their profound impact on the health of the communities they work in.
Kalangala – Healthcare Ambassadors through Music
Kalangala, one of the Ssese Islands in Lake Victoria, has the highest percentage of HIV infection in Uganda at 18.8%. This compares to a Ugandan national average of 7.3% according to the PHIA Project.
BfA provides a Music & Life-Skills and HIV/AIDS awareness programme for disadvantaged children and young people on the island. Through weekly training sessions and a partnership with the District Health Office, this programme has made a significant contribution towards the goal of an AIDS-free generation and the reduction of stigma associated with the condition.
Health Clubs take place alongside music sessions, with the objective of creating Health Ambassadors within the community. Brass for Africa’s latest monitoring and evaluation process has confirmed an increased knowledge of HIV/AIDS amongst young people on the island from 50% to 72%, and a reduction in stigma of those living with HIV/AIDS from 34% to an impressive 18%. You can learn more about this programme here.
Muwala Asobola Community Project (MACI)
MACI was set up with the support of BfA to help girls and young women to achieve their physical, intellectual and social potential as individuals, members of their community and responsible citizens.
A key challenge it addresses is period poverty – a lack of access to menstrual products, sanitation, and education on how to manage menstruation – which is a significant block to girls’ participation in education and attainment in the communities that MACI works with. They have developed a programme to produce and distribute sanitary pads, which BfA makes available to all girls participating in its projects. This simple intervention ensures that no girls are excluded from BfA music and life skills training, and underpins BfA’s mission of improving gender equality in the communities it serves. You can learn more about this programme here.
Bidibidi – Music for Healthcare Inclusion
One of the world’s largest refugee settlements, Bidibidi is based in Yumbe, Northern Uganda. It is home to over 240,000 refugees, and over the past seven years, BidiBidi has transformed from a rapidly growing camp for refugees fleeing South Sudan’s civil war to a permanent settlement.
Through its LAB UGANDA community music programme, BfA provides health support to young people in the settlement by developing local health ambassadors and connecting them to community members. Key activities are mental health dialogues in community spaces, menstrual health management sessions in schools and hand hygiene demonstrations throughout the settlement. You can learn more about the programme here.
All three of these programmes deliver more than preventative healthcare – they are actually creating and supporting healthy behaviours and practice in vulnerable communities, and reinforcing the social determinants of health. And it’s the powerful and inclusive channel of music which attracts these young people to participate.
All are designed and delivered as partnerships, enabling reach and sustainability. The Kalangala Health Ambassadors programme is supported by the Mercury Phoenix Trust; MACI serves as BfA’s partner in providing sanitary protection to all girls participating in BfA’s progtrammes; the Music for Health Inclusion programme at BidiBidi is supported by a partnership with Music Connects.
Here in the UK, we face multiple challenges to improving the health of individuals and communities and to restoring confidence in the NHS. Local, community-led initiatives that create and support health can play a cumulative and sustained role in meeting these challenges. The small interventions that BfA has made in Uganda show us what is possible and offer inspiration, truly demonstrating that health begins at home and in our local communities – hospitals are for repairs.
Clare Delmar
Listen to Locals
13 October 2024
