By Dr Stellah Wairimu Bosire
Founder and Executive Director, Africa Center for Health Systems and Gender Justice
Africa’s health systems are investing heavily in community health workers, primary healthcare, digital health and stronger referral systems. These investments are necessary. But we believe there is an important layer of community health infrastructure that remains insufficiently recognised: organised women’s movements.
Across the continent, women organise through chamas, savings groups, mothers’ groups, cooperatives, survivor networks, faith communities and community-based organisations. These structures are often treated as beneficiaries of health programmes or as convenient channels through which health messages can be delivered. We think this significantly underestimates their role.
Women’s movements are already influencing how communities understand health, when people seek care, whether referrals are completed, how information travels, healthcare financing, how families respond to illness and how communities make sense of their interactions with health systems. The question, therefore, is not whether these networks participate in health systems.
The more important question is whether health systems recognise, strengthen and meaningfully connect them to formal structures. At the Africa Center for Health Systems and Gender Justice, we believe women’s movements should be understood as part of the social infrastructure required to build resilient health systems.
This does not mean replacing trained community health workers, nurses or other healthcare professionals. It does not mean creating a parallel health workforce. Rather, it means strengthening the structures that already exist around formal healthcare and recognising the important work that happens before someone ever reaches a facility.
A woman first has to recognise that something is wrong. She has to know where to seek care. She may need information she trusts. She may have to find transport, negotiate childcare, overcome stigma or obtain money. Someone may have to encourage her to complete a referral. These decisions are shaped by families and communities. That is why strengthening health systems requires more than strengthening facilities and formal health workers. It requires strengthening the relationships, networks and institutions that connect people to those systems.
There is already substantial evidence behind this proposition. Research across several low- and middle-income countries has shown that women’s groups using participatory approaches can improve maternal and newborn health outcomes. Studies have also shown improvements in breastfeeding, contraceptive use, immunisation and engagement with maternal health services where women participate in organised community groups.
Kenya provides an important example. Research conducted in Trans Nzoia County found that women participating in community health volunteer-led group interventions had better outcomes across postpartum follow-up, exclusive breastfeeding, contraception and childhood immunisation compared with women receiving standard community health volunteer visits.
Community health systems work better when communities themselves are organised. This is where we believe an important opportunity exists. Women’s movements can strengthen prevention and health promotion. They can help communities recognise health risks earlier. They can support people to navigate referrals. They can counter misinformation. They can identify recurring barriers to care. And because they are embedded within communities, they can generate knowledge about health needs that formal health information systems may never see.
Most health data is generated when people interact with formal systems. We count clinic attendance, diagnoses, medicines, vaccinations and referrals. But health systems often know far less about the people who never arrive. They may not know why a woman abandoned a referral, why adolescents are avoiding a particular service, why misinformation is spreading, why women are presenting late with cervical cancer, or why technically available services remain inaccessible. Communities often know these things long before institutions do.
Women’s networks can therefore become important sources of what we describe as community-generated health intelligence. This is not about creating another parallel data system. It is about creating stronger feedback loops between communities and health institutions. What are women seeing? What are they hearing? Which barriers are emerging? What services are failing? Where is misinformation circulating? Which referrals are repeatedly breaking down? When these patterns are systematically documented and connected to health-system decision-making, community experience becomes more than anecdotal evidence. It becomes an input into planning, priority-setting and policy.
This is particularly important as governments and global health institutions increasingly speak about resilience. A resilient health system cannot simply be one that responds effectively when a crisis occurs. Resilience must also mean having trusted networks, credible information channels, functioning referral pathways and community leadership already in place before a crisis begins.
The Ebola and COVID-19 epidemics taught us this repeatedly. Trust cannot suddenly be manufactured during an emergency. Community participation cannot be improvised after a crisis has begun. The infrastructure has to exist beforehand. Women’s movements are part of that infrastructure. However, there is an important caution. Health systems have historically relied heavily on women’s unpaid labour. We should not respond to shortages in formal health systems by simply assigning more responsibilities to women.
Strengthening women’s movements must therefore not become another mechanism for extracting unpaid labour. There is a difference between strengthening collective capability and transferring service-delivery responsibilities. Women’s networks can be equipped to support prevention, health literacy, early identification, referral navigation, community evidence and accountability. But where programmes require substantial reporting, routine service provision or significant time commitments, that work must be properly resourced.
Resilient health systems cannot be built through the invisible labour of women. This distinction is fundamental to how the Africa Center approaches our EQUIP work. We are strengthening women’s movements as partners within health systems while maintaining clear connections with formal community health structures. Imagine a health system in which a woman receives credible health information through a trusted local network; recognises symptoms early; is connected quickly to a community health worker or facility; receives support to complete that referral; and can then communicate her experience of the system back through an organised community structure.
Now imagine that these experiences are systematically aggregated. Perhaps women are repeatedly unable to access a particular service. Perhaps misinformation about contraception is spreading across several communities. Perhaps maternal mental health concerns are appearing but are rarely identified in facilities. Perhaps referral costs are preventing women from completing specialist care. This information can then move upwards: from women’s networks, into community health systems, facilities, county planning processes and ultimately national policy.
For too long, health systems have asked how women can be reached. We should instead be asking how women can help shape the systems themselves. Women’s movements should not simply be places where health programmes go to find beneficiaries. They can be part of the architecture through which communities prevent illness, navigate care, generate evidence and hold health systems accountable.
If Africa is serious about resilient, people-centred health systems, we need to recognise and invest in the infrastructure that communities have already built. Much of that infrastructure is being held together by women.
