There is a model of public health intervention that treats communities as the target of programmes designed elsewhere. The technical experts design the intervention. The programme teams implement it. The community receives it. This model is almost always wrong, and it is often harmful.
Communities are not passive. They have existing knowledge about health and disease. They have social structures that shape how information flows and how decisions are made. They have histories with health systems, both positive and negative, that affect how they respond to new programmes. They have priorities that may differ from the priorities of the programme.
When immunisation campaigns have faced resistance in parts of northern Nigeria, the response from programme teams has sometimes been to intensify communication, as if the barrier were simply lack of information. But the communities resisting were often not uninformed. They were making decisions based on their prior experiences, their religious and cultural frameworks, and their assessment of what was being offered and what they were not being offered in return.
The programmes that made real progress were the ones that engaged community and religious leaders not as validators to be recruited, but as genuine partners in understanding community concerns and shaping the response. They were the ones that asked what the community needed, not just what the programme needed from the community.
This is not a soft, feel-good addition to programme design. It is a practical necessity. Programmes that do not have genuine community buy-in will underperform in ways that are expensive and difficult to reverse. A vaccination campaign that creates refusal in a community will find subsequent campaigns harder, not easier, because each failed interaction deposits mistrust.
In practice, meaningful community engagement requires time, humility, and a genuine willingness to modify programme design based on what you learn. Those are uncomfortable requirements for programmes with short timelines and fixed designs. But they are the requirements.
The communities we work in are not our audience. They are our partners. The sooner programme design reflects that, the more effective the programmes will be.