Consistency queen in it! 👋Hello and welcome back to my blog!
Last week, we established that access opens the door, but inclusion keeps it open for everyone. We discussed how systems can be accessible yet fundamentally exclusive. This time around, let’s move past philosophy and look at proof. Inclusion isn’t just being kind; it’s a health strategy, a powerful one in fact. It has improved health outcomes, especially for marginalised groups.
When we listen, adapt and show respect, the results are undeniable
- The Power of Peer-Led Services.
In many communities, young people and key populations (like sex workers) are often excluded from standard health services due to the paralysing fear of stigma, judgement, or criminalisation. This exclusion forces individuals to delay seeking help, leading to severe health consequences and poor community outcomes.
A two-year trial in Zambia evaluated peer-led community hubs that provided essential sexual and reproductive health (SRH) education and services to adolescents aged 15–24. These hubs were deliberately positioned outside of intimidating traditional clinics and were staffed by young people trained to act as peer educators and navigators.
The results of this intentional design were undeniable. 64% of participants accessed at least one key SRH service (such as counselling, contraception, or STI testing), compared to just 5.4% in areas without intervention. This success wasn’t merely about increasing availability; it was about making the services acceptable and trusted. By prioritising peer leadership and operating in non-clinical, community-centric spaces, the program effectively dismantled the fear of being seen or judged, which is often the most significant barrier to care.
By building a health program on the principles of dignity and inclusion, and by ensuring the front-line staff mirror the population they serve, the system achieves genuine health equity. This model provides more than just access; it creates a culture of belonging that ensures young people who were previously invisible to the health system now actively participate in their own wellness.
- Eliminating linguistic and cultural barriers.
While implementing a program in northern Kenya in 2024, I quickly learned the value of having someone from the community on the facilitation team. It broke down both language and cultural barriers in ways that no translation app ever could.
In Marsabit, I discovered that many participants couldn’t read or write, but that didn’t mean they couldn’t understand. Using more visuals and having a local facilitator helped bring every message to life in a relatable way. I also learned that their culture didn’t allow specific family relations (like in-laws) to face each other, which was the silent reason why many women were withdrawing from the discussion. I rearranged the seating to respect that cultural boundary.
That small act of inclusion changed everything. Participation improved, people took notes, shared ideas, and followed through. It proved that bridging linguistic and cultural gaps isn’t complicated; it just requires intentionality and respect.
- Dignity by design.
Inclusion for persons with disabilities (PWDs) goes beyond a ramp. It must be woven into every culture of care. Let’s give a practical example: There’s a ramp to access the building, but the waiting room seating isn’t adaptable. The forms aren’t available in Braille, there’s no visual or hearing aid for communication, and most damagingly, the medical staff speak to the caregiver instead of the patient.
When we talk about inclusion of PWDs, we often stop at infrastructure and leave out communication. True inclusion begins when we see and treat PWDs as active participants in their own care, not as extensions of their caregivers.
Accessibility must include respect, autonomy, and dignity. Designing for dignity means asking:
- Can this person participate fully in their care?
- Have we considered how they communicate, move, or experience this space?
- Do our systems reflect empathy, or just compliance?
When inclusion is designed with dignity, it’s not about “helping” people, it’s about ensuring they belong.
Inclusion: The Engine of Sustainable Public Health
In each of these examples, the principle is the same: inclusion isn’t a cost but an investment in effectiveness. An exclusive system creates gaps that later become expensive emergencies. Designing programs with inclusion at the outset will achieve better community buy-in and result in higher rates of retention and adherence.
As we continue to push for sustainable systems, let’s always remember its more than policies and clinics. Always count experiences. Inclusion is the culture that determines whether public health truly works for everyone.
What successful inclusion stories have you seen in your own community? Please share them in the comments below! If you liked this, don’t forget to like the post and share it with your circle. Also, subscribe to be notified of my next post.
Until our next heart-to-heart conversation……….
References.
Phiri, M.M., Schaap, A., Hensen, B. et al. (2024) ‘The impact of an innovative community-based peer-led intervention on uptake and coverage of sexual and reproductive health services among adolescents and young people 15–24 years old: results from the Yathu Yathu cluster randomised trial’, BMC Public Health, 24, Article 1424. doi:10.1186/s12889-024-18894-z.
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