Community Engagement in Global Health Settings

Written by Hayley Mundeva (Website Manager) and Prince Adu (Events Coordinator)

This year, the UHRA was invited back to facilitate a break-out session at the 4th Canadian Global Health Students and Young Professionals Summit on Saturday, October 28th in Ottawa. Prince and myself were invited to speak on the topic of ‘community engagement.’

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That’s a loaded theme! At times, in global health, it almost seems like community engagement is becoming a buzz word. But what does it actually mean, or look like, to do community engaged work? What does engagement really mean? How do we define a community? Because how we define and understand these terms is inevitably going to influence how we try to bring these concepts to life in real world settings.

At the UHRA, we like to push the dial a bit and really dive into these issues. We like to dig deeper into the practical and ethical challenges that can form the backdrop to global health work. Otherwise it’s easy to turn a blind eye, or nod our heads and assume we’re doing it the ‘right’ way, when in reality, we may not be, or worse, we could even be causing harm.

To start the session, we tried to unpack the term ‘community.’ As one of the participants made a great job of pointing out, communities are not necessarily defined by geographic boundaries. Rather, people become part of a community if they have something in common. So in global health settings, if a research project is being carried out in a low-income setting in hopes of eventually improving tuberculosis service provision, for instance, anyone who may be impacted by that project in some capacity could be defined as being part of that community. This includes community members, local hospitals/clinics, the funders of the project, local research partners who are helping to carry out the work, and so forth.

It’s important to think about these various groups because sometimes, complex interactions can undergird relationships between community stakeholders. Especially if we are ‘outsiders’ and did not grow up in the settings that we are working in, we may not be aware of these dynamics. For instance, do you need to go through a regulatory body in a local country in order to get your research project approved? Why is that? Or perhaps you need to gain support from a community leader so that your project can be locally endorsed? If we don’t make an effort to become aware of these dynamics, we can easily lose trust, may not be invited back into these settings, and ultimately, not have the impact on people’s health that we are hoping to achieve.

As one participant made note of, community engagement is particularly important because power imbalances often influence our work, which is deeply rooted in histories of colonization and inequality. For instance, as a white Canadian who has pursued work in East Africa, I have to recognize that many structural inequalities frequently disadvantage individuals from accessing the health care services they need. Within this work, I often find myself having to question my motivations. Am I just coming in to this community for my own needs and interests? Or how do I avoid turning community members into ‘guinea pigs’ for this research? As Prince even brought up, he grew up in Ghana yet pursued post-secondary education in the United States and Canada. As a result of his global education, he is sometimes seen as an outsider, even in Ghana.

At its core, community engagement means that we have to acknowledge these deep-rooted histories, while questioning our own locations within this work, even if it can be uncomfortable at times. This is increasingly important because cultural and language barriers are often present in global health projects, which can cause us to easily draw our own conclusions or misunderstand things.

Towards the end, the discussion moved towards recognizing that community engaged work will look different in different settings. It is context-specific. And arguably, acknowledging these issues, and why they are important, will likely never end. It is an ongoing process that we need to keep grappling with as global health practitioners.