In the first half of 2025, sweeping cuts to foreign aid began to impact health programmes across Africa. Health workers faced supply gaps, planned campaigns were delayed, and national programmes that had relied on external funding found themselves managing uncertainty.

It was in this period that, in one district in the Democratic Republic of Congo, ALMA Youth Corps members arrived ahead of a mosquito net distribution and called a community meeting, and worked with residents to define their own criteria for who would receive nets. They formed a committee to oversee the planning, and validated the lists themselves. When distribution was done, Youth Corps members came back for home visits to make sure families knew how to hang the nets correctly. 

“For us, the process mattered as much as the nets,” says Alexis Kabambi, who co-leads the DRC Youth Corps. “When communities are involved in decisions about resources meant for them, they take ownership in a completely different way.”

This approach has been central to what ALMA’s Youth Corps has been doing across six African countries over the past year. Through the Global Fund’s  Gender Equality Fund initiative, young people in the DRC, Eswatini, Mozambique, Nigeria, Uganda, and Zambia have been running a structured, community-driven process to identify and address the gender barriers that determine whether women and girls can access health services, including for malaria. In 2025, over 3,000 community members participated in community scorecard sessions across the six countries, with women in the majority at every location.

The methodology works through structured dialogue. Youth Corps members facilitate separate sessions with women, men, adolescent girls, and adolescent boys, asking them to score their local health facility on access, quality, and gender responsiveness. The scores are reviewed alongside health workers and local leaders, action plans are developed with clear responsibilities and timelines, and the process is repeated quarterly. Communities track whether what they raised actually leads to change, including tracking their own agreed responsibilities.

The findings across the six countries were specific and actionable. In Eswatini, women were being charged to use the toilet at their health center, which deterred many from attending. After it was raised in dialogue, the fee was removed, a cleaner was assigned, and renovations implemented. Suggestion boxes were introduced so patients could raise concerns going forward. In Nigeria, outpatient and inpatient malaria cases were being recorded together, making data analysis difficult, whilst communities identified health facility staffing leading to long waiting times A dedicated malaria register was introduced following community scorecard sessions, and when chronic understaffing was escalated to the Commissioner for Health, the government committed to adding staff according to the identified needs. In Uganda’s Nalugai Health Centre, women attending health services had no privacy in the maternity ward, shared unlabeled toilets, and no security for evening visits, while some identified language barriers as a key barrier. By October 2025, curtains had been installed, toilets labeled by gender, a night guard hired, and a bilingual nurse recruited to serve communities that had been excluded by language barriers. In Mozambique, persistent medicine stockouts were raised during scorecard sessions and escalated by the health facility director to the district supply chain office. Supply was restored, and community confidence in the facility improved.

What the community dialogues uncovered in DRC

In DRC, the conversations surfaced barriers that rarely appear in national health data. When Patricia Mweze, Bukavu Provincial Lead and Gender Focal Point for the DRC Youth Corps, and her colleagues created structured spaces for women to speak, the issues went beyond waiting times or distance to facilities.

“Women talked about not having a say in their own health decisions, about fears that their information would not stay private, and about risk of violence while collecting water that affected how freely they could move,” Patricia says. “These things do not show up in facility statistics, but they directly affect whether women seek care.”

The DRC community dialogues drew 120 participants each, with an equal split between men and women. Engaging men and traditional leaders alongside women was deliberate, given that shifting attitudes toward gender in health-seeking requires broader community involvement. Alongside the community work, the DRC Youth Corps presented their findings to the Parliamentary group of the National Assembly and to parliamentarians from Kasai. A formal plenary session is being planned to continue this engagement and bring scorecard evidence into legislative deliberation.

Within the corps itself, 17 female members in DRC were trained through an ALMA-led female leadership programme that reached over 130 young women across 17 countries. “Gender equality work has to be reflected in who is leading it,” Alexis says. “Building female leadership within the corps has been as important as any of the external advocacy we have done.”

The changes pursued in Zambia

In Zambia’s Chilanga and Monze districts, 511 community members  participated in community dialogue sessions, 56 percent of them women. One of the issues raised was the attitude of health workers toward patients, something communities had experienced but had limited channels to address formally.

“People were staying away from clinics because of how they had been treated,” says Justine Mumba, who co-leads the Zambia Youth Corps with Natasha Mumba. “That is a real barrier to care, and the scorecard process gave communities a structured way to raise it.”

Staff-patient relations were added as a standing agenda item in weekly health facility meetings and health workers were re-oriented. Community satisfaction scores in subsequent rounds reflected the change. Beyond this, health facilities now allow patients to choose the gender of their attending health worker and are required to maintain gender balance among service providers. “Women should be able to decide who examines them,” Natasha Mumba says. “We raised it through the process, and it is now in place.”

The Zambia Youth Corps has also engaged at national level. The national co-lead attended a health planning meeting convened by the Minister of Health, bringing community scorecard findings into that discussion.

Carrying findings into policy spaces

Community dialogue findings have been consistently brought to higher-level forums throughout the initiative. In Mozambique, the Youth Corps organized an advocacy session at the national parliament attended by 15 Members of Parliament, who heard scorecard findings and committed to a joint action plan ahead of the national budget vote. In Uganda, 25 MPs attended a similar session. In Eswatini, the Youth Corps was formally adopted into the national gender stakeholders’ forum, giving youth a standing presence in national gender and health policy discussions.

“When we presented our findings to MPs, we came with community scorecards, numbers, and specific examples from the ground,” says Hilder Namuddu, co-lead of the Uganda Youth Corps. “That is what made the conversation different from a general advocacy visit.”

Across the six countries, 95 female leaders were trained in 2025, and 62 percent of Youth Corps members are women. National-level implementation in Mozambique, Nigeria, Uganda, and Zambia is led by female members.

“Getting the Commissioner for Health to commit to additional staffing was the result of a process,” says Grace Atinuke Felix, Gender Focal Point, Nigeria Malaria and NTDs Youth Corps. “Communities had documented the problem through the scorecard, we escalated it with evidence, and that gave the conversation weight it would not otherwise have had.”

“We are bringing evidence from communities into rooms where decisions are made,” Patricia Mweze says. “That is what makes the connection between community dialogue and policy change concrete rather than theoretical.”

Looking ahead, community dialogues will continue through 2026 across all six countries. The DRC plenary with the National Assembly will take scorecard evidence into a formal legislative setting. The Mozambique Youth Corps will return to MPs with an action plan before the budget vote. A gender-malaria e-course and toolkit completed in 2025 will support peer learning and extend the methodology to new country contexts.

International Women’s Day 2026 carries the theme of rights, justice, and action for all women and girls. For the Youth Corps, those words describe work already underway. In six countries, young people have spent the past year building the connections between what communities say they need, what health facilities actually provide, and what governments are willing to fund and prioritize. The gaps are significant and the work continues, but in clinics, meeting rooms, and parliamentary chambers across the continent, the evidence of what changes when communities are genuinely heard is becoming harder to ignore.

Contributors

This feature was developed with contributions from:

• Alexis Kabambi, co-lead of the DRC Malaria Youth Corps
• Patricia Mweze, South Kivu Provincial Lead and Gender Focal Point, DRC Malaria Youth Corps
• Justine Mumba and Natasha Mumba, co-leads of the Zambia Malaria Youth Corps
• Dr. Hilder Namuddu, Co-Lead of the Uganda Malaria Youth Corps
• Grace Atinuke Felix, Gender Focal Point, Nigeria Malaria and NTDs Youth Corps

Learn more at www.alma2030.org/our-work/youth