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Building Resilient Health Systems: A 2035 Vision

Why we need to create hyper-local and resilience-based community health systems supported and empowered by community health workers who are competent, well remunerated and well connected within the formal health system.

Earlier this month, I was delighted to speak at the OECD netFWD’s 2021 Annual Meeting. Organized in partnership with the OECD Foresight Unit, this year’s meeting provided a space to look into the future, anticipate some of the most salient threats to humanity, and identify opportunities for philanthropy to expand and strengthen efforts to build green and sustainable societies in a post-2030 world. I shared our vision of a world where healthcare is resilient and preventative; why community health workers are at the core of that vision; and how funding bodies can collaborate for systems change.

COVID-19 has brought to light the vital need to rethink the way health systems are delivered, financed and governed across the globe. The pandemic has illustrated the vital role frontline health workers play at the center of health systems; how our health is interconnected and therefore only as strong as the weakest link; and the importance of agile systems that are in touch with the realities on the ground. As the worldwide distribution of COVID-19 vaccines ushers us into a new phase in the pandemic response, we believe that the time is right to shift from disease-centric to resilience-centric thinking.

With healthcare at the top of every government agenda—not to mention front and center in every individual mind—how can we seize this opportunity to build forward better, make bold decisions and work towards resilient health systems that focus on prevention, not just cure?

Moving from curative to preventative healthcare systems

In many ways, resilient-centered health starts at an individual level: by empowering citizens to own and manage their health as much as possible. On the other hand, putting full responsibility on individuals carries the risk of exacerbating inequality, by ignoring the impact of social determinants, like poverty, education, racial, social justice and economic instability. So how can we implement structural change to better connect individuals to the wider system? The answer lies in community health.

The Johnson & Johnson Center for Health Worker Innovation was founded to catalyze efforts to respond to the human resource crisis in global health and help build a thriving health workforce. The Center is tasked with guiding a $250 million, 10-year commitment to support one million nurses, midwives and community health workers reaching 100 million people by 2030 and the more immediate $50 million commitment to support frontline health workers battling COVID-19. Guided by the Center for Health Worker Innovation and funded by the Johnson & Johnson Foundation, we support the people on the front lines of delivering care, from nurses and midwives to community health workers. We know that truly resilient systems are proactive rather than reactive—reaching out to people rather than responding to disease – and that health workers are vital to this shift.

Our long-term vision is to create community health systems that are hyper-local and resilience-based; and that help communities to come together and address some of their health challenges. To make this possible, communities have to be supported and empowered by a community health worker—providing the knowledge and resources for communities to have greater access to health close to home. Whether a pharmacist, a community nurse or a community health navigator, we want each and every community health worker to be well remunerated, have a strong curriculum of competence and knowledge, and to be well connected within the formal health system.

Inspired by the Global South, in time we hope to change the pyramid from a very specialized, facility-based, fee-for-service, curative healthcare model to a new model of care centered around people and designed to promote holistic health for individuals, communities and systems. This requires long-standing collaboration with government, civil society, and the private and public sectors so that we don’t just create a new parallel track but really embed this approach within policies.

Formalizing and rewarding frontline health workers

It’s clear that when communities are empowered to manage and own their health, it not only increases health equity but also strengthens disease response across the whole health system. In fact, those countries and regions whose health systems were already strongly reliant on community health and primary care systems have had an advantage of being able to deliver hyperlocal health interventions to respond to the pandemic.

Health workers are at the heart of this community-based approach but a lack of training, resources, supervision, growth opportunities, emotional support and recognition is impacting their ability to deliver quality care. In many countries, community health is not yet top of mind and would require a significant rethink of citizens’ and patients’ pathways. With a deficit of 18 million health workers globally, we need to think strategically about what the frontline health worker of the future will need to succeed in their roles. Community health provides a task-shifting opportunity to nurture individual and communities’ resilience, improving health outcomes while alleviating the burden on the primary care and specialized health systems.

Partnering for change

If you want to be truly catalytic as a funding body, you have to bring together actors across government, public and private sectors to share in the same vision. We work across the board with our partners to nurture ecosystems of change, knowing that genuine, long-lasting impact cannot be achieved without collective action.

For example, one of the most significant obstacles to creating resilient healthcare systems is the siloed funding across the health sector. Breaking down these silos is essential to address the systemic challenges faced by individuals, communities and frontline health workers.

So, what can other Foundations and actors do to join us on this journey?

  • Contribute to the collective learning journey to better articulate a common aspiration to shift the focus from disease to resilience
  • Commission research on the return on investment around community health in developed countries
  • Join advocacy efforts to make the case for community health, to allow future health systems to sustain good health as opposed to curing diseases
  • Give voice to those currently trying, testing and failing to establish community health systems in developed countries
  • Generate evidence around what works and the design principles behind successful community health interventions

Join us in asking: how can we be bold and come together with a joint vision that can’t be overlooked? We believe that every funder needs to embrace their convening power to encourage collective work for systems change. If not us, who? If not now, when?