Working Towards Inclusive, Socially Accountable and Resilient Community Health Systems: An Introduction to a Special Issue

Document Type : Editorial


1 School of Public Health, University of Zambia, Lusaka, Zambia

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

3 School of Public Health and SAMRC Health Services to Systems Research Unit, University of the Western Cape, Cape Town, South Africa


This editorial introduces the eleven papers in the special issue titled: The multiple lenses on the community health system: implications for research and action. Our editorial begins by describing the collaboration that led to the special issue, and then gives an overview of the contents of the special issue, which include two framing papers and nine empirical contributions from researchers in Zambia, Tanzania, Sweden, South Africa, India, and Australia. We conclude by considering how these papers collectively speak to the theme of resilience.



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  1. Sacks E, Schleiff M, Were M, Chowdhury AM, Perry HB. Communities, universal health coverage and primary health care. Bull World Health Organ. 2020;98(11):773-780. doi:2471/blt.20.252445
  2. Pfaffmann Zambruni J, Rasanathan K, Hipgrave D, et al. Community health systems: allowing community health workers to emerge from the shadows. Lancet Glob Health. 2017;5(9):e866-e867. doi:1016/s2214-109x(17)30268-1
  3. World Health Organization (WHO), United Nations Children’s Fund (UNICEF). Operational Framework for Primary Health Care: Transforming Vision into Action. Geneva: WHO, UNICEF; 2020.
  4. Chaminuka collective. Lenses, Metaphors and Research Priorities on Community Health Systems. Report of Workshop, Chaminuka Lodge, Lusaka, Zambia, 10-14 June 2019. Cape Town: Universities of the Western Cape, Zambia and Umeå; 2019.
  5. George AS, LeFevre AE, Schleiff M, Mancuso A, Sacks E, Sarriot E. Hubris, humility and humanity: expanding evidence approaches for improving and sustaining community health programmes. BMJ Glob Health. 2018;3(3):e000811. doi:1136/bmjgh-2018-000811
  6. George AS, Scott K, Mehra V, Sriram V. Synergies, strengths and challenges: findings on community capability from a systematic health systems research literature review. BMC Health Serv Res. 2016;16(Suppl 7):623. doi:1186/s12913-016-1860-1
  7. Sacks E, Morrow M, Story WT, et al. Beyond the building blocks: integrating community roles into health systems frameworks to achieve health for all. BMJ Glob Health. 2018;3(Suppl 3):e001384. doi:1136/bmjgh-2018-001384
  8. Abimbola S. The foreign gaze: authorship in academic global health. BMJ Glob Health. 2019;4(5):e002068. doi:1136/bmjgh-2019-002068
  9. Zulu JM, Maritim P, Silumbwe A, et al. Unlocking trust in community health systems: lessons from the lymphatic filariasis morbidity management and disability prevention pilot project in Luangwa District, Zambia. Int J Health Policy Manag. doi:10.34172/ijhpm.2021.133
  10. Assegaai T, Schneider H. Factors associated with workplace and interpersonal trust in the supervisory system of a community health worker programme in a rural South African District. Int J Health Policy Manag. doi:10.34172/ijhpm.2021.03
  11. Mathias K, Rawat M, Thompson A, Gaitonde R, Jain S. Exploring community mental health systems – a participatory health needs and assets assessment in the Yamuna Valley, North India. Int J Health Policy Manag. 2021. doi:34172/ijhpm.2020.222
  12. Sirili N, Simba D, Zulu JM, Frumence G, Tetui M. Accommodate or Reject: The Role of Local Communities in the Retention of Health Workers in Rural Tanzania. Int J Health Policy Manag. 2021. doi:34172/ijhpm.2021.77
  13. Baum F, Freeman T. Why community health systems have not flourished in high income countries: what the Australian experience tells us. Int J Health Policy Manag. 2021. doi:34172/ijhpm.2021.42
  14. van Ryneveld M, Whyle E, Brady L. What Is COVID-19 Teaching Us About Community Health Systems? A Reflection From a Rapid Community-Led Mutual Aid Response in Cape Town, South Africa. Int J Health Policy Manag. 2021. doi:34172/ijhpm.2020.167
  15. Jonsson F, Carson DB, Goicolea I, Hurtig A-K. Strengthening Community Health Systems Through Novel eHealth Initiatives? Commencing a Realist Study of the Virtual Health Rooms in Rural Northern Sweden. Int J Health Policy Manag. 2021. doi:34172/ijhpm.2021.08
  16. Sutherns T, Olivier J. Mapping the multiple health system responsiveness mechanisms in one local health system: a scoping review of the Western Cape provincial health system of South Africa. Int J Health Policy Manag. doi:10.34172/ijhpm.2021.85
  17. Bridgland VME, Moeck EK, Green DM, et al. Why the COVID-19 pandemic is a traumatic stressor. PLoS One. 2021;16(1):e0240146. doi:1371/journal.pone.0240146
  18. Barasa EW, Cloete K, Gilson L. From bouncing back, to nurturing emergence: reframing the concept of resilience in health systems strengthening. Health Policy Plan. 2017;32(Suppl_3):iii91-iii94. doi:1093/heapol/czx118
  19. Gilson L, Barasa E, Nxumalo N, et al. Everyday resilience in district health systems: emerging insights from the front lines in Kenya and South Africa. BMJ Glob Health. 2017;2(2):e000224. doi:1136/bmjgh-2016-000224
  20. Topp SM. Power and politics: the case for linking resilience to health system governance. BMJ Glob Health. 2020;5(6):e002891. doi:1136/bmjgh-2020-002891
  21. Walraven G. The 2018 Astana Declaration on primary health care, is it useful? J Glob Health. 2019;9(1):010313. doi:7189/jogh.09.010313
  22. Biddle L, Wahedi K, Bozorgmehr K. Health system resilience: a literature review of empirical research. Health Policy Plan. 2020;35(8):1084-1109. doi:1093/heapol/czaa032
  23. Haldane V, De Foo C, Abdalla SM, et al. Health systems resilience in managing the COVID-19 pandemic: lessons from 28 countries. Nat Med. 2021;27(6):964-980. doi:1038/s41591-021-01381-y