When health systems are weak, people can go without quality care, suffer more from preventable and treatable diseases, and often face financial burdens. In turn, communities lose trust in their health systems and choose not to seek out care even when they need it most — creating a cycle of sickness and death.

For a health system to function well, it needs to be properly staffed, stocked, and financed. This means having an adequately trained and staffed health workforce, available essential medicines, a maintained infrastructure, and financial protections.

This is where health systems strengthening (HSS) projects come in as a vehicle for achieving health objectives like universal health coverage and improving the performance of health systems – including the quality, accessibility, and responsiveness of health services.

HSS bolsters the resilience of health systems to withstand both the test of time and emerging threats. However, this work doesn’t fall on development projects alone — it takes commitment from government, civil society, private sector, and communities alike to drive real and lasting change.

Leading with Communities

Several HSS organisations and groups convened in a recent policy forum entitled “It Takes a Village: Community-Led Development as a Path Towards Inclusive and Resilient Health Systems.” During the event, Frances Ilika, Palladium’s Director of Health Systems, emphasised the need for participatory mechanisms, explaining that community structures and processes provide the opportunity for communities to voice their own health and development needs and for health leaders to listen, react, and incorporate.

The forum showcased local teams’ unique approaches to driving systems transformation. One such project is USAID Keneya Sinsi Wale, whose local partner, Groupe Pivot Santé Population worked with community actors to ensure health services are more responsive to community needs in Mali.

Those long-standing, trusted relationships within communities, strong health expertise, and first-hand understanding of local realities positioned them to help communities understand their role within the health system, participate in decision-making and governance, and have a direct impact on their own health outcomes.

When these pieces come together, the result is clear: communities are empowered and in the driver’s seat on issues that concern them. Unique needs are addressed and local resources are leveraged.

It paints a clear picture of what’s needed for HSS and as we look ahead to 2025, here’s what our experts and Forum attendees expect to see from the sector.

Data

In 2025, we must continue building a strong marriage between analytics and health systems and service delivery. Local expertise can be a real asset here; since data production is only one piece of the puzzle, local expertise goes a step further to drive data to action in communities where the impact is felt firsthand.

Data for Implementation (Data.FI) project is using artificial intelligence to empower communities through information and data analytics from community-led monitoring, a way of collecting data about HIV services.

The process of collecting community-led monitoring data can be burdensome due to the numerous complicated sources data are extracted from, so Data.FI trained its own chatbot model to learn dozens of community-led monitoring topics to support HIV program evaluation and insights for effective and efficient implementation.

Communities are now seeing improved program outcomes and are equipped with valuable accountability mechanisms that they can continue to use.

Co-Creation

The expertise and experience needed to improve health systems goes beyond health care and service delivery. It’s also important to leverage diverse yet complementary skills and co-create integrated programming for maximized benefits across health and other sectors.

NPI EXPAND did just this when tackling high teenage pregnancy rates and maternal mortality rates in Narok County — home to Kenya’s biggest conservation and wildlife areas, the Masai Mara. The local team engaged diverse community structures, such as traditional birth attendants, school clubs, wildlife committees, and rangers, to build a group of champions equipped to tackle family planning, maternal health, gender, and environmental issues within their own community, and sustain momentum even after the program ends.

“Co-creation leads to ownership of community challenges at all levels,” shares Josephine Mbiyu, Palladium’s Capacity Strengthening and Sustainability Advisor who led NPI’s work in Kenya. “Using existing structures that already have community trust is a great way to sustain interventions.”

By the end of the project, which concluded this past October, NPI and the community champions had improved reproductive health indicators — seeing a 62% increase in the number of new family planning users from September 2022 to March 2024 — and established interventions to prevent maternal and neonatal mortalities.

Cultural Relevance

In Nigeria, the UK-funded Lafiya project is using religious traditions as an entry point to promote an equitable roll out of the country’s national health insurance. While the scheme is intended to reduce financial burdens and improve access for Nigerians, many were not enrolled because of low acceptance of the scheme, causing a lack of demand, and financial constraints.

By employing the community’s culturally relevant practice of Waqf — the Muslim tradition of donation or purchasing an asset — Lafiya leveraged local knowledge and customs to improve health care financing. As a result, the project helped mobilize US$1.45 million for health and enrol over 1,300 new members in Nigeria’s national health insurance program. Dr. Hassana Adamu, technical lead of Nigeria Lafiya celebrated the fact that “the community-level approach is capable of driving national policy implementation … to achieve national targets while addressing equity concerns.”

The new year offers the perfect opportunity to pause, reflect, and recalibrate on HSS approaches. Ensuring these lessons in community leadership and leveraging diverse skills are infused in all programming from the onset of an activity is key in moving health systems forward.

With communities identifying health priorities and leading decision-making alongside their government, they are in the driver’s seat of their own health reforms and able to sustain these gains for years to come. As a result, health systems are stronger, more resilient, and able to deliver accessible, quality health services that improve people’s lives, not hinder them.

Watch the webinar recording to learn more about the promise of community-led development and achievements from USAID Keneya Sinsi Wale, NPI EXPAND, FCDO Lafiya Nigeria, and Data.FI.