Where and How do Communities Fit into People-Centred Health Systems?

“The science and practice of people-centred health systems.” This was the official theme of the Third Global Symposium on Health Systems Research, which took place in Cape Town, South Africa, in late 2014, and it resonated in all sorts of interesting ways with symposium participants. “People-centred health systems” is a relatively new concept, and participants offered many thoughtful insights about how it relates to their work.

People-centredness in health systems, while a highly desirable quality, is different from community involvementAlong these lines, a point emphasised across numerous symposium sessions was the importance of community involvement. What does this mean in the context of the health systems field? What might community involvement in a specific health system look like? I submit the following brief observations not to over-simplify the issue, but rather to help spark a conversation that needs to happen in order for new ways of thinking to emerge.

First, people-centredness in health systems, while a highly desirable quality, is different from community involvement. A health service might be planned and delivered with the needs and priorities of its intended users foremost in mind, but this does not always mean that the intended users participate as a community in helping to make the service what it is.

Second, there are many potential ways for communities to be involved in health systems – so many that a taxonomy would be useful for delineating and tracking different types of community involvement. At the Third Global Symposium, presentations focusing on the role of community health workers and on the value of community-based participatory research featured prominently. But other key aspects of community involvement in health systems remain largely unexplored. These include the community’s role in helping to maximise health research impacts and community representation in health system governance. Attention is also needed to key health system paradigms such as the World Health Organization (WHO) health system “building blocks,” which have been the subject of a recent online discussion pertaining to patient engagement and the related concept of community engagement.

It is time to advocate for the issue of community involvement to be given a more prominent place in the health systems discourseThird, the experience of co-authoring the World Hepatitis Alliance’s first-ever Global Community Hepatitis Policy Report has convinced me and my colleagues that innovative platforms are needed for translating community knowledge into real health system gains. For this 2014 publication, the World Hepatitis Alliance asked civil society organisations worldwide to comment on information their national governments had submitted to WHO for the 2013 Global policy report on the prevention and control of viral hepatitis in WHO Member States . The 95 respondents to our survey included numerous hepatitis patient groups and community-based organisations. These stakeholders demonstrated great acumen in terms of holding their governments accountable for shortcomings in national viral hepatitis responses as well as expressing their communities’ priorities.

In sum, it is time to advocate for the issue of community involvement to be given a more prominent place in the health systems discourse. Communities hold the key to better health system performance and better health outcomes. I look forward to this principle being affirmed through new health system initiatives and new forms of collaboration among diverse stakeholders.

[Jeffrey Victor Lazarus, Senior Researcher, University of Copenhagen, and Secretariat Director of Health Systems Global]