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I am the System, We are the System

Thinking systemically and providing opportunities for those operating at all levels of the health system to engage in a transformative journey from curative to resilient health.
CHWI - Nurse checking young boy as he sits  on his father's lap CHWI - Nurse checking young boy as he sits  on his father's lap

At the Johnson & Johnson Center for Health Worker Innovation, we believe that frontline health workers are central to the future of health and that our role is to be a catalyst for change by engaging our partners, diversifying the voices around the table, and enabling conversations on the future of health systems.

But why do we need to take a systemic approach to health systems transformation? And how do we ensure that our work isn’t simply a sticking plaster but is contributing to long-lasting change? In the following piece, I have attempted to unravel these two vital questions.

Building resilient health systems

Our goal at the Center is to respond to the human resource crisis in global health by training and supporting health workers, but we have a bolder aspiration too: to examine how health systems can be grounded in the front line for a stronger systemic shift towards a new model of resilient healthcare that works for everyone.

While these goals are often viewed as distinct from one another, they are, in fact, deeply interconnected. We cannot achieve Universal Health Coverage without adequate numbers of resilient health workers; and we cannot close the health worker gap without systems that support them, from paying them properly and on time, to supplying them with proper equipment. Community health provides a task shifting opportunity to alleviate the burden on the overall health system, making it more effective, as well as to push healthcare delivery upstream—intercepting diseases, rather than curing them.

We know that resilient-centered health requires individuals to be able to manage their own health as much as possible, while taking into account the impact of significant social determinants. Community health is the key to connecting individuals to the wider system, with frontline health workers able to reach out to people proactively and build long-term relationships, rather than to respond reactively to disease.

Frontline health workers as ‘system shifters’

Frontline health workers—especially nurses, midwives, and community health workers—are often the first and only link between communities and health systems. What’s more, many work within regions that are already dealing with the effects of significant global issues, witnessing daily the connection between planetary health, gender equality, mental health and physical human health. As they work within these complex circumstances, frontline health workers are already innovating within their communities, doing things differently with the patient’s best interests in mind.

This is why we believe that frontline health workers are sometimes well placed to be the ‘system shifters’ needed to strengthen (or even transform) health systems, prepare for future pandemics, and deepen the connection to primary care. In order to achieve these ambitions, we not only need more community health workers but to ensure there is an enabling environment, equipped with adequate skills, resources and long-term support.

Putting our vision into practice

In order for our programs to be truly effective, we need to think systemically and provide opportunities for those operating at all levels of the health system, from health workers to the policymakers funding care, to engage in this transformative journey from curative to resilient health.

A recent example of this approach in action is our work with the Forum for the Future and the School of System Change. Our partnership with the Forum has resulted in two principal outputs: a Basecamp program to equip practitioners with the tools and methodology of systems change, and a series of conversations curated with the Forum’s dialogue space, to harness collective intelligence from and with thinking leaders in this space.

With both the Basecamp program and the conversation series, we brought together individuals from across the global healthcare system over a shared desire to build a healthier, equitable and more resilient future. Via the conversations we gained valuable insight into the levers of transformation needed to achieve our goals, while Basecamp participants worked to solve their real-world challenges through a systemic lens.

Systems do not occur of their own accord; they are created by and made up of people. Systems change happens when individuals are able to access their own agency, imagine a better future and translate their ambition into action. To have the impact we want to achieve, we must adopt a broader lens: not only training and supporting frontline health workers but empowering them to have a catalytic impact on the systems within which they operate.

Join the discussion via the Forum for the Future’s Futures Centre here.