CATHCA’s Message Ahead of the Global Fund’s Eighth Replenishment Summit
As world leaders prepare to gather in Johannesburg for the Global Fund’s Eighth Replenishment Summit on 21 November 2025, the Catholic Health Care Association of Southern Africa (CATHCA) shares a simple, urgent message: to defeat HIV, TB and malaria, we must reach the communities so often left behind. Health care is not just about medicines or clinics, it is about people, especially those on the margins who are too often invisible. Their struggles and resilience must be at the heart of the fight against these diseases.
Lives at the Edges of the Health System
In many parts of Southern Africa, underprivileged and marginalised populations face daily struggles in accessing even the most basic health services. In informal settlements on the edges of our cities, where families live in makeshift shacks, some women are forced to give birth in backroom shelters due to the absence of maternity care or fear of seeking it. In remote rural and farming areas, poverty and distance turn even a simple check-up into an overwhelming ordeal. In mining communities, fear and stigma often drive workers to hide their illnesses, allowing TB and other diseases to spread quietly as miners avoid seeking care to protect their livelihoods. Disadvantaged migrants and refugees, living under the constant threat of xenophobia, hesitate to approach health facilities out of fear of rejection, discrimination or deportation. Many endure suffering in silence, excluded from a health system that feels out of reach. Yet in each of these situations, there is hope: local caregivers, volunteers, faith groups and small clinics continue to serve as trusted anchors, bridging the gap between underserved communities and the broader health system.
Faith and Compassion at the Core
Community health care is rooted in the God-given dignity of every person, a deep compassion for those who are vulnerable and a commitment to justice for those who are left out. It views health care not simply as the treatment of disease but as the care of the whole person: heart, body, mind and spirit. In practice, this person-centred way of working treats each patient as more than a number or a case: they are a human being with a story, a family and inherent worth. Community health workers often go beyond providing medicine: they offer a comforting hand, a listening ear and the reassurance that someone cares.
Faith-rooted organisations and groups embedded in local communities frequently play a vital role in earning trust. Neighbours recognise them from church or community gatherings and feel safe approaching them without fear of judgment. In contexts where migrants or the poorest members of society may hesitate to seek care, a church-linked or community-run health service is often seen as welcoming and non-discriminatory. Many such groups openly oppose exclusion and affirm the principle that no person should be denied care because of who they are. This spirit of acceptance allows an undocumented mother to seek help without fear and a miner living with illness to access services without shame. And the ethos of “welcoming the stranger” becomes a lived expression of faith and compassion within communities.
Holistic, Community-Based Care That Works
Across Southern Africa, community-rooted health initiatives have built strong networks of care that reach deep into areas where formal services are limited or absent. These efforts are often supported by small clinics, home-based care teams, faith-based groups and volunteer organisations that serve as trusted pillars within their neighbourhoods. Whether in a cluster of farms in Limpopo, an informal settlement in Gauteng or rural communities in Mpumalanga and KwaZulu-Natal, local actors remain on the ground, working tirelessly to ensure that people most in need can access essential health care.
This model of care is holistic and deeply relational. A community clinic may integrate HIV testing with TB screening, provide nutrition support for children or organise malaria prevention in remote villages. Community health workers take the time to build relationships, understand the pressures families face and address emotional or social needs alongside physical health. They may console someone newly diagnosed with HIV, support a TB patient through their treatment journey or ensure a neighbour receives care when they have not shown up for medication. Trust and local knowledge are at the heart of this work.
Community-based care also strengthens the broader health system. Rather than replacing government services, local organisations complement and connect with them. Volunteers and health workers receive training and mentorship that equip them to serve their communities effectively. Small outreach organisations are supported to improve their tools, management and continuity of care. Coordination with the Department of Health and local authorities helps community programmes align with national priorities and contribute to public health strategies. A door-to-door HIV education drive or a home-based TB support programme becomes part of a larger effort to prevent illness, improve treatment adherence and detect outbreaks early.
Community-led care is sustainable. Even when specific projects end, trained caregivers remain in their communities, trust persists and strengthened systems continue to save lives. When local groups have the skills, support and relationships they need, community-based health care builds long-term resilience and ensures that people in the most overlooked places continue to receive compassionate, consistent care.
A Call to Action: Invest in Communities for Health
As the Global Fund and international partners convene in South Africa, there is much to celebrate in the progress made and the countless lives saved through investments in HIV, TB and malaria responses. Yet this moment also calls for renewed commitment. The fight against these diseases will be won only if efforts reach those who remain far from the centres of care. The call that “where you live shouldn’t determine whether you live” must guide every policy and funding decision. A child in a rural village in Eastern Cape or a migrant worker in Free State deserves the same chance at life as anyone in a well-resourced urban setting. Accepting a world where illness and death follow the lines of poverty, geography or documentation status is simply not an option.
We therefore urge governments, donors and people of goodwill to strengthen investment in community-based health care. This includes directing resources to grassroots initiatives that understand local languages, build trust through presence and recognise the lived realities of the communities they serve. Faith-rooted, community-run and civil society organisations often stand closest to those who are otherwise excluded. Their role is essential in delivering care that is accessible, human-centred and responsive. With increased support, more home-based caregivers can reach the sick, more community outreach teams can prevent treatment interruptions and more local health workers can be trained to provide compassionate, dignified care.
This call is not about advancing any one organisation. It is about affirming a principle of social justice: that the poor, the rural, the marginalised and the migrant must not remain at the edges of the health system. In the spirit of Ubuntu — “I am because we are” — solidarity with those who suffer requires bringing health services closer to their doorsteps and sustaining the hope that lives within communities. Investing in the people who dedicate themselves to caring for their neighbours helps build a future where no mother gives birth unattended in a shack, no TB patient is left to struggle alone and no one dies simply because care arrived too late.
Andrea Cortemiglia
CATHCA Executive Director