Public Health Approaches to Infectious Disease
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# 4.3 Community action against infectious diseases

Raising the standards of public health is not simply a matter of training more doctors and nurses, building more hospitals and providing more funding for vaccines and treatments – although all of these make substantial contributions. As the earlier examples of mass vaccination campaigns and the promotion of hand washing with soap illustrate, much of the work involved in delivering effective public health strategies against infectious disease occurs in the community, outside the formal healthcare system.

As the famous definition of public health by Winslow (1920) states, ‘organized community effort’ is an essential element of successful strategies against infectious disease. The success of public health strategies all over the world, but especially in low-resource economies, and more particularly in rural areas and slum or shanty settlements, relies crucially on community action, mobilised and directed by community health workers like the Health Extension Workers in Ethiopia (Video 1), often with minimal training. For example, the malaria-screening service shown earlier in Figure 6 is run by a community health worker with basic training and rudimentary equipment.

Give an example of community action in rural Ethiopia based on your study of Video 1.

## Answer

You might have thought of the campaign by Asafesh to persuade households in the Fura community to build latrines and ban open defaecation in the fields. Fura was the first kebele in Southern Ethiopia to become 100% free of open defaecation (Figure 15). (Remember that a kebele is the smallest administrative unit in Ethiopia, covering about 1000 households distributed among several small communities.)

Figure 15 The award given to Fura ‘in acknowledgement of the communities’ dedication in spearheading Hygiene and Sanitation in Ethiopia’
© Basiro Davey
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However, it is sobering to note that, globally, more than 1.2 billion people still lack basic sanitation and have no alternative but to defaecate in fields and on rubbish heaps and waste ground.

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