Submission ID 131591
| Issue/Objective | Armed conflict destroys health systems and deepens inequities, yet communities in war zones develop local resilience strategies that global health policy overlooks. In Sudan, DRC, and Burkina Faso, displaced persons, community health workers (CHWs), and local accountability committees lead life-saving adaptations, but their voices are excluded from funding and policy decisions. The objective of this is to synthesize existing evidence on community-led health system resilience in these three conflict-affected African settings, and provide actionable guidance for donors and policymakers on how to center marginalized voices. |
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| Methodology/Approach | We conducted a scoping review (2019-2025) of peer-reviewed literature and humanitarian reports (WHO, MSF, ICRC, UNICEF) focused on Sudan (Darfur), DRC (North Kivu), and Burkina Faso (Sahel region). To center marginalized voices without primary data collection, due to active conflict, we analyzed fourteen published first-person testimonies from CHWs and displaced persons, plus six community-generated accountability reports from Sudanese resistance committees and DRC community health boards. Two practitioners with field experience in DRC and Burkina Faso reviewed our findings for face validity. |
| Results | Five community-led mechanisms emerged across all three settings: 1. Decentralized drug stockpiles hidden from looters in Darfur. 2. CHW-led disease surveillance continuing despite 3. closed clinics in North Kivu. 3. Community accountability report cards tracking vaccine stockouts in Sudan 4. SMS-based referral coordination past insurgent checkpoints in Burkina Faso 5. Task-shifted digital screening (documented in comparable contexts). Direct testimonies reinforce these findings: "We keep medicines where bombs don't look" (Sudan, ICRC); "The clinic is empty, but we are still walking" (DRC, MSF); "The phone is our ambulance" (Burkina Faso, UNICEF). A key lesson learned is that CHWs in conflict zones prioritize compensation, supplies, and recognition, yet donors systematically underfund these essentials. |
| Discussion/Conclusion | Resilience is not a technical problem but a power and accountability problem. Centering marginalized voices requires three shifts: 1. During-conflict adaptive funding to local committees 2. Donor accountability pacts co-designed with community health boards 3. Paid, protected CHWs. We offer a three-step implementation guide: map local mechanisms, redirect flexible funding, and establish monthly joint accountability reviews. Reclaiming global health equity means trusting communities already leading solutions, not designing resilience for them from afar. |
| Presenters and Affiliations | Chidinma Nwuta Public Health Interest Group Africa Miracle Agbontale Public Health Interest Group Africa |
