79 Beatrice Halpaap, John C. Reeder. Ethiop Med J, 2019, Vol. 57, No. 1 PERSPECTIVES SOCIAL INNOVATION: ENGAGING COMMUNITIES IN IMPROVING THEIR OWN HEALTH Beatrice Halpaap, MPH, Pharm D 1* , John C. Reeder, PhD 1 One billion people around the world still lack access to basic healthcare services, despite the development of novel technologies (1). Providing quality health care and getting medicines, vaccines and diagnostics to those who need them most is a great challenge. Most health systems in low- and middle-income countries fail to reach all of their populations, in particular the most marginalized and those in greatest need remain neglected. Community engagement to achieve universal health The 2030 sustainable development agenda recognizes health as a critical factor for wellbeing and aims to address the healthcare delivery gap. It places universal health coverage at the heart of the Sustainable Development Goals, in order to reach the most vulnerable populations and leave no one behind (2). To achieve this we need to shift our culture of working and develop innovative approaches. We need to work increasingly in partnership with the vari- ous sectors involved in order to bring diverse disciplines and broaden our perspectives and knowledge. We need to place people at the centre of health services and engage healthcare users in taking control of their own health. Community engagement is one of the key factors in driving this culture shift. The importance of community par- ticipation in primary health care had already been recognized in the declaration of Alma Ata back in 1978 and since then has been demonstrated in many examples in Africa (3). The critical role of community engagement was shown during the 2013-2016 Ebola virus outbreak, where a good understanding of the local culture and the rela- tionship and the trust built with the community members were important factors in allowing an effective response (4). Achieving universal health coverage requires a new paradigm, placing community engagement at the core of our efforts (5). Social innovations to engage communities and leave no one behind Social innovation provides innovative solutions to address the healthcare delivery gap, engaging communities and the various health system actors in different sectors. It is defined by Phyllis and co-authors as “the process of in- venting, securing support for, and implementing novel solutions to social needs and problems” (6). Social innova- tions occur in many parts of Africa. They are led by individuals who often would not call themselves “innovators”, but see that they can play a role in addressing the health care challenges they face through simple and affordable solutions. The example of Chipatala Cha Foni (CCPF) in Malawi illustrates how communities can play a key role in improv- ing their own health and in working in partnership with the government and nongovernmental organizations to sustain and scale up their efforts. In remote and rural communities in Malawi, distance often prevents people from seeking healthcare when they need it. “When I submitted my idea, I believed that it would save lives and improve access to healthcare. People get discouraged to go to hospitals because of the type of care that they expect to get and when you add the misinformation going around, a lot of myths going around that lead to a lot of deaths in in- fants. I believe technology can help bridge that” says Suyapi Mumba (7), a social innovator. His idea became real- ity through the establishment of CCPF, the health centre by phone. CCPF is a toll-free hotline that provides reliable health information and referrals on demand. It was initiated in one district in 2011 in collaboration with the Minis- try of Health, Concern Worldwide, village chiefs and the private sector. CCPF was expanded by the non- government organization VillageReach and now operates in nine districts and is accessible to more than five mil- lion people, enhancing their knowledge on health and access to referral. AWARE, the Action for Women and Awakening in Rural Environment in Uganda, is another example that shows the role that community members can 1 UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland. *Corresponding author, halpaapb@who.int