Strengthening Research and Practice in Community Health Systems: A Research Agenda and Manifesto

Document Type : Short Communication


1 School of Pharmacy, University of Waterloo, Waterloo, ON, Canada

2 Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden

3 Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda

4 School of Public Health & Family Medicine (SPHFM), University of Cape Town, Cape Town, South Africa

5 School of Public Health, University of the Western Cape, Cape Town, South Africa

6 South African Medical Research Council Health Services to Systems Unit, University of the Western Cape, Cape Town, South Africa

7 Centre for the Study of Equity and Governance in Health Systems, Guatemala City, Guatemala

8 A full list of the investigators of the Chaminuka Collective is provided at the end of the article


While there have been increased calls for strengthening community health systems (CHSs), key priorities for this field have not been fully articulated. This paper seeks to fill this gap, presenting a collaboratively defined research agenda, accompanied by a ‘manifesto’ on strengthening research and practice in the CHS. The CHS research agenda domains were developed through a modified concept mapping process with a team of 33 experts on the CHS including policy-makers, implementers and researchers from institutions in six countries: Uganda, Guatemala, South Africa, Sweden, Tanzania and Zambia. The process began remotely with brainstorming research priorities and concluded in a one-week workshop that was held in Zambia where priorities for strengthening CHS were discussed, grouped into domains, interpreted, and drafted into a collective declaration. Eight domains of research priorities for CHSs were identified: clarifying the purpose and values of the CHS, ensure inclusivity; design, implementation and monitoring of strategies to strengthen the CHS; social, political and historical contexts of CHS; community health workers (CHWs); social accountability; the interface between the CHS and the broader health system; governance and stewardship; and finally, the ethical methodologies for researching the CHS. By harnessing a set of diverse and rich experiences and perspectives on CHS through a structured process, a multifaceted research agenda and manifesto that transcend context, disciplines and time were developed. We posit this as an entry into greater debate and diversity in the field as we continue to find ways to strengthen research and practice in the CHS.



"Watch the Video Summary"


  Check the full list of "CHS-Connect" special issue here

  1. Schneider H, Lehmann U. From community health workers to community health systems: time to widen the horizon? Health Syst Reform. 2016; 2(2):112-118. doi:10.1080/23288604.2016.1166307
  2. Agarwal S, Kirk K, Sripad P, Bellows B, Abuya T, Warren C. Setting the global research agenda for community health systems: literature and consultative review. Hum Resour Health. 2019;17(1):22. doi:10.1186/s12960-019-0362-8
  3. Byskov J, Maluka S, Marchal B, et al. A systems perspective on the importance of global health strategy developments for accomplishing today’s Sustainable Development Goals. Health Policy Plan. 2019; 34(9):635-645. doi:10.1093/heapol/czz042
  4. Chairperson(s): Francesco Zambon, Groenewegen P. 2.C. Round table: setting the research agenda on health systems and policy for small states in the European region: organised by: EUPHA section on health services research, Islands & Small States Institute, University of Malta, Department of International Health, CAPHRI School of Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University. Eur J Public Health. 2016;26(Suppl 1):ckw165-009. doi:10.1093/eurpub/ckw165.009
  5. Abma TA, Broerse JE. Patient participation as dialogue: setting research agendas. Health Expect. 2010;13(2):160-173. doi:10.1111/j.1369-7625.2009.00549.x
  6. Dannenberg AL, Jackson RJ, Frumkin H, et al. The impact of community design and land-use choices on public health: a scientific research agenda. Am J Public Health. 2003;93(9):1500-1508. doi:10.2105/ajph.93.9.1500
  7. Johnson DB, Quinn E, Sitaker M, et al. Developing an agenda for research about policies to improve access to healthy foods in rural communities: a concept mapping study. BMC Public Health. 2014;14:592. doi:10.1186/1471-2458-14-592
  8. Dagenais C, Ridde V, Laurendeau MC, Souffez K. Knowledge translation research in population health: establishing a collaborative research agenda. Health Res Policy Syst. 2009;7:28. doi:10.1186/1478-4505-7-28
  9. Trochim W, Kane M. Concept mapping: an introduction to structured conceptualization in health care. Int J Qual Health Care. 2005;17(3):187-191. doi:10.1093/intqhc/mzi038
  • Receive Date: 03 September 2020
  • Revise Date: 01 June 2021
  • Accept Date: 16 June 2021
  • First Publish Date: 11 July 2021