International Approaches to Community-Based Health

Von Suzanne Ferron & Kate Molesworth / Direktion für Entwicklung und Zusammenarbeit DEZA

Despite much progress of the last fifty years, the right to health remains largely unrealised for many people in low-income countries. In recognition of the multi-sectoral approaches that are necessary to address poverty, most international organisations have moved away from the classical project-level focus of intervention to a more holistic approach. Correspondingly, many organisations have broadened their understanding of the concept of health and the determinants of ill health, at least implicitly if not explicitly.

The declaration of the International Conference on Primary Health Care at Alma Ata in 1978 heralded an era of emphasis on primary health care and a focus on promoting the participation of communities in health care provision. The current use of community-based health interventions reflects a broader understanding of the determinants of ill-health and several organisations engage in integrated projects and programmes. In very broad terms, two main approaches can be identified in community-based interventions: the behaviour change approach and the empowerment approach. Most international organisations appear to employ a mixture of the two approaches. Some organisations have moved beyond the more traditional areas of community-based health focus such as maternal and child health and reproductive health, to cover such issues as gender-based violence and disability.

While many international organisations recognise the importance of promoting participation and empowering communities, however, there is little evidence of specific community-based health strategy development. Systematic research into the impact of different approaches and interventions in community-based health is also lacking, however, recently some innovations and techniques have emerged such as partnership defined quality (PDQ) and self evaluation for effective decision making – systems for communities to adapt, learn and expand (SEED-SCALE). The absence of specific strategies on community-based health reveals an inadequacy in the analysis and rigorous evaluation of such interventions. It is important that this be addressed to enable organisations with rights-based health goals to determine which community-based health interventions and approaches might be most effective in achieving these.

Kate Molesworth ( and Suzanne Ferron. The Swiss Agency for Development Cooperation (SDC) has a long-term interest in community-based approaches to health. Several papers on specific aspects and the overall approach to this theme are published on the SDC websites ( and