For a parent in eastern Democratic Republic of Congo, a child’s fever is no longer a simple health concern. The nearest clinic may be closed, short of medicines or located beyond an unsafe road. The illness may be malaria, measles or another common infection; amid the current Ebola outbreak, an unexplained fever can also bring profound fear. What should be an ordinary journey for care becomes a frightening calculation of distance, cost, insecurity and trust. For many families, waiting can feel like the only option, even when waiting is dangerous. Across Goma, Bukavu and conflict-affected territories of North and South Kivu, violence has fractured supply routes, displaced families and drained health facilities of staff and medicines. A September 2025 International Committee of the Red Cross assessment found that 85 per cent of surveyed facilities faced medicine shortages and nearly 40 per cent had lost health workers. Now Ebola is adding another layer of danger. By August 26, the World Health Organization had recorded 5,794 confirmed cases and 2,786 deaths in the DR Congo, with Ituri as the epicentre and North Kivu the second-most affected province. But, as Médecins Sans Frontières has warned, Ebola is not arriving alone. Malaria, cholera, measles, malnutrition, maternal and newborn complications, sexual violence, psychological distress and interrupted treatment for HIV, tuberculosis and chronic diseases continue to enter the same homes. Families do not experience these threats as separate programmes. They experience them as one daily struggle to survive. Yet this vast country still possesses a powerful health resource: people who know their communities, speak their languages and are trusted enough to enter their homes. Properly selected, trained and supported community health workers can become the centre of gravity of a health system under pressure, connecting households, facilities, outbreak teams, local leaders and humanitarian services. At household level, they can teach practical measures for safe water, hygiene, mosquito control and nutrition using available foods. They can screen children for malnutrition, recognise dehydration and other danger signs, identify risks during pregnancy and after childbirth, and provide psychological first aid. They can share accurate sexual and reproductive health information and connect survivors of sexual violence to confidential care. Where national protocols permit, trained community health workers can test and manage uncomplicated malaria, provide oral rehydration for diarrhoea and support adherence to treatment for tuberculosis, HIV and noncommunicable diseases. During Ebola and other outbreaks, early warning, trusted risk communication, support for contact follow-up and rapid referral can help communities act sooner and response teams reach people faster. Their greatest contribution may be connection. A community health worker does not merely tell a sick person to “go to hospital.” The worker can recognise urgency, alert the receiving facility, guide the family through referral options and follow up after treatment. Information also travels back: facilities and outbreak teams gain a trusted channel for reaching communities. This relationship can rebuild confidence where fear, misinformation and repeated institutional failure have weakened public trust. Rwanda’s experience offers a relevant regional lesson. Its nationwide community-based management of childhood illness brought the diagnosis and treatment of malaria, pneumonia and diarrhoea closer to families. Eastern DR Congo requires a model shaped by its own communities and conflict realities, but the principle is transferable: care organised around trusted local workers and connected to referral services makes distance less deadly. The practical pathway is clear. Health zones and partners should map existing community health workers and trusted women, youth and disability leaders. Training should use short, competency-based modules followed by refresher sessions and supportive supervision. In line with WHO guidance, each worker needs a defined catchment area, clear protocols, a basic kit, reliable medicines and commodities, secure communication, referral contacts and fair, predictable remuneration. These are not administrative additions; they turn community commitment into dependable public-health capacity. Across eastern DR Congo, every constructive effort to protect life deserves recognition. In areas under AFC/M23 administration, public reporting has documented locally organised Ebola response structures supporting disease surveillance, laboratory testing, contact follow-up and containment measures. These efforts demonstrate that practical health coordination is possible even within a divided operating environment. They provide a foundation for deeper cooperation among health professionals, community leaders, humanitarian organisations and regional partners. Investment should build on this local capacity, beginning where access is weakest and measuring progress through earlier referrals, timely treatment, continuity of care, reliable outbreak alerts and stronger community trust. Hospitals remain indispensable. But their expertise comes too late when no one recognises a danger sign, initiates basic care or helps a family reach them. A capable community health worker brings the health system to the household while keeping the pathway to professional care open. Eastern DR Congo cannot wait for perfect stability before rebuilding access to healthcare. It can begin by investing in people whom communities already know. When those people are trained, equipped, connected and valued, community health is no longer the edge of the system. It becomes the foundation from which the entire system can recover. The writer is a Public Health Consultant
