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Beyond the building blocks: integrating community roles into health systems frameworks to achieve health for all
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Achieving ambitious health goals—from the Every Woman Every Child strategy to the health targets of the sustainable development goals to the renewed promise of Alma-Ata of ‘health for all’—necessitates strong, functional and inclusive health systems. Improving and sustaining community health is integral to overall health systems strengthening efforts. However, while health systems and community health are conceptually and operationally related, the guidance informing health systems policymakers and financiers—particularly the well-known WHO ‘building blocks’ framework—only indirectly addresses the foundational elements necessary for effective community health. Although community-inclusive and community-led strategies may be more difficult, complex, and require more widespread resources than facility-based strategies, their exclusion from health systems frameworks leads to insufficient attention to elements that need ex-ante efforts and investments to set community health effectively within systems. This paper suggests an expansion of the WHO building blocks, starting with the recognition of the essential determinants of the production of health. It presents an expanded framework that articulates the need for dedicated human resources and quality services at the community level; it places strategies for organising and mobilising social resources in communities in the context of systems for health; it situates health information as one ingredient of a larger block dedicated to information, learning and accountability; and it recognises societal partnerships as critical links to the public health sector. This framework makes explicit the oft-neglected investment needs for community health and aims to inform efforts to situate community health within national health systems and global guidance to achieve health for all.
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“An expansion of the six WHO building blocks has been proposed that highlights community-based service delivery as well as community mobilizing and organization, with attention to nontraditional health system components such as social capital, inter-sectoral partnerships, local governance, equitable financing, community information and data systems, and household production of health [101].”
From Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” (2021) · cites this paper as [101]
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Cites
Closing the gap in a generation: health equity through action on the social determinants of health
Marmot, M. G., Friel, S., Bell, R., Houweling, T. A. J., & Taylor, S. A. J. (2008) · The Lancet · doi:10.1016/s0140-6736(08)61690-6 · Cited by 8,473
The United Nations Development Programme
Oestreich, J. E. (2017) · Oxford University Press eBooks · doi:10.1093/acprof:oso/9780190637347.003.0003 · Cited by 4,875
What works? Interventions for maternal and child undernutrition and survival
Bhutta, Z. A., Ahmed, T., Black, R. E., Cousens, S. N., Dewey, K. G., Giugliani, E. R. J., Haider, B. A., Kirkwood, B. R., Morris, S. S., Sachdev, H. S., et al. (2008) · The Lancet · doi:10.1016/s0140-6736(07)61693-6 · Cited by 2,264
Box, G. E. P. (1976) · Journal of the American Statistical Association · doi:10.1080/01621459.1976.10480949 · Cited by 2,114
An Analytical Framework for the Study of Child Survival in Developing Countries
Mosley, W. H., & Chen, L.-C. (1984) · Population and Development Review · doi:10.2307/2807954 · Cited by 1,490
Bhutta, Z. A., Das, J. K., Bahl, R., Lawn, J. E., Salam, R. A., Paul, V. K., Sankar, M. J., Blencowe, H., Rizvi, A., Chou, V. B., et al. (2014) · The Lancet · doi:10.1016/s0140-6736(14)60792-3 · Cited by 1,367
Continuum of care for maternal, newborn, and child health: from slogan to service delivery
Kerber, K. J., de Graft‐Johnson, J., Bhutta, Z. A., Okong, P., Starrs, A., & Lawn, J. E. (2007) · The Lancet · doi:10.1016/s0140-6736(07)61578-5 · Cited by 1,001
Systems thinking for health systems strengthening.
de Savigny, D., & Adam, T. (2009) · Cited by 873
Social Accountability: What Does the Evidence Really Say?
Fox, J. A. (2015) · World Development · doi:10.1016/j.worlddev.2015.03.011 · Cited by 873
Manandhar, D. S., Osrin, D., Shrestha, B. P., Mesko, N., Morrison, J., Tumbahangphe, K. M., Tamang, S., Thapa, S., Shrestha, D., Thapa, B., et al. (2004) · The Lancet · doi:10.1016/s0140-6736(04)17021-9 · Cited by 847
Effect of handwashing on child health: a randomised controlled trial
Luby, S. P., Agboatwalla, M., Feikin, D. R., Painter, J., Billhimer, W., Altaf, A., & Hoekstra, R. M. (2005) · The Lancet · doi:10.1016/s0140-6736(05)66912-7 · Cited by 748
Björkman, M., & Svensson, J. (2009) · Quarterly Journal of Economics · doi:10.1162/qjec.2009.124.2.735 · Cited by 739
Prost, A., Colbourn, T., Seward, N., Azad, K., Coomarasamy, A., Copas, A. J., Houweling, T. A. J., Fottrell, E. F., Kuddus, A., Lewycka, S. O., et al. (2013) · The Lancet · doi:10.1016/s0140-6736(13)60685-6 · Cited by 651
Baqui, A. H., Arifeen, S. E., Darmstadt, G. L., Ahmed, S., Williams, E., Seraji, H. R., Mannan, I., Rahman, S. M. M., Shah, R., Saha, S. K., et al. (2008) · The Lancet · doi:10.1016/s0140-6736(08)60835-1 · Cited by 587
An analytical framework for the study of child survival in developing countries. 1984.
Mosley, W. H., & Chen, L.-C. (2003) · PubMed · Cited by 566
Gilmore, B., & McAuliffe, É. (2013) · BMC Public Health · doi:10.1186/1471-2458-13-847 · Cited by 465
Salway, T. J., Bogaert, L., Rhodes, A. E., Brennan, D. J., & Gesink, D. (2016) · American Journal of Public Health · doi:10.2105/ajph.2016.303088 · Cited by 456
Glenton, C., Colvin, C., Carlsen, B., Swartz, A., Lewin, S., Noyes, J., & Rashidian, A. (2013) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd010414.pub2 · Cited by 454
Time to initiation of breastfeeding and neonatal mortality and morbidity: a systematic review
Debes, A. K., Kohli, A., Walker, N., Edmond, K. M., & Mullany, L. C. (2013) · BMC Public Health · doi:10.1186/1471-2458-13-s3-s19 · Cited by 390
Community participation: lessons for maternal, newborn, and child health
Rosato, M., Laverack, G., Grabman, L. H., Tripathy, P., Nair, N., Mwansambo, C., Azad, K., Morrison, J., Bhutta, Z., Perry, H., et al. (2008) · The Lancet · doi:10.1016/s0140-6736(08)61406-3 · Cited by 379
Examining the links between community participation and health outcomes: a review of the literature
Rifkin, S. B. (2014) · Health Policy and Planning · doi:10.1093/heapol/czu076 · Cited by 369
Box, G. E. P. (1976) · Journal of the American Statistical Association · doi:10.2307/2286841 · Cited by 366
Peer Support for the Hardly Reached: A Systematic Review
Sokol, R. L., & Fisher, E. B. (2016) · American Journal of Public Health · doi:10.2105/ajph.2016.303180 · Cited by 230
Berman, P., Kendall, C., & Bhattacharyya, K. (1994) · Social Science & Medicine · doi:10.1016/0277-9536(94)90390-5 · Cited by 215
Mounier‐Jack, S., Griffiths, U. K., Closser, S., Burchett, H., & Marchal, B. (2014) · BMC Public Health · doi:10.1186/1471-2458-14-278 · Cited by 185
Gillespie, A. M., Obregón, R., Asawi, R. E., Richey, C., Manoncourt, E., Joshi, K., Naqvi, S., Pouye, A., Safi, N., Chitnis, K., et al. (2016) · Global Health Science and Practice · doi:10.9745/ghsp-d-16-00226 · Cited by 185
Effectiveness of Breastfeeding Peer Counseling in a Low-Income, Predominantly Latina Population
Chapman, D. J., Damio, G., Young, S., & Pérez‐Escamilla, R. (2004) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/archpedi.158.9.897 · Cited by 182
Black, R. E., Taylor, C. E., Arole, S., Bang, A., Bhutta, Z. A., Chowdhury, A. M. R., Kirkwood, B. R., Kureshy, N., Lanata, C. F., Phillips, J. F., et al. (2017) · Journal of Global Health · doi:10.7189/jogh.07.010908 · Cited by 182
Health systems frameworks in their political context: framing divergent agendas
van Olmen, J., Marchal, B., Damme, W. V., Kegels, G., & Hill, P. (2012) · BMC Public Health · doi:10.1186/1471-2458-12-774 · Cited by 152
Maternal social capital and child nutritional status in four developing countries
Silva, M. J. D., & Trudy Harpham, C. (2006) · Health & Place · doi:10.1016/j.healthplace.2006.02.005 · Cited by 132
Farnsworth, S. K., Böse, K., Fajobi, O., Souza, P. P., Peniston, A., Davidson, L. L., Griffiths, M., & Hodgins, S. (2014) · Journal of Health Communication · doi:10.1080/10810730.2014.941519 · Cited by 108
Hofmeyr, G. J., Gülmezoglu, A. M., Novikova, N., Linder, V., Ferreira, S. R. G., & Piaggio, G. G. (2009) · Bulletin of the World Health Organization · doi:10.2471/blt.08.055715 · Cited by 107
Story, W. T. (2014) · Health & Place · doi:10.1016/j.healthplace.2014.03.011 · Cited by 103
Self-citationPrevention of postpartum hemorrhage at home birth in Afghanistan
Sanghvi, H., Ansari, N., Prata, N., Gibson, H., Ehsan, A. T., & Smith, J. M. (2010) · International Journal of Gynecology & Obstetrics · doi:10.1016/j.ijgo.2009.12.003 · Cited by 102
Innovative financing for health: what is truly innovative?
Atun, R. A., Knaul, F. M., Akachi, Y., & Frenk, J. (2012) · The Lancet · doi:10.1016/s0140-6736(12)61460-3 · Cited by 91
Perry, H. B., Morrow, M., Borger, S., Weiss, J., DeCoster, M., Davis, T., & Ernst, P. (2015) · Global Health Science and Practice · doi:10.9745/ghsp-d-15-00051 · Cited by 90
Self-citationHo, L., Labrecque, G., Batonon, I., Salsi, V., & Ratnayake, R. (2015) · Conflict and Health · doi:10.1186/s13031-015-0055-4 · Cited by 75
Ebola interventions: listen to communities
Kutalek, R., Wang, S., Fallah, M. P., Wesseh, C. S., & Gilbert, J. (2015) · The Lancet Global Health · doi:10.1016/s2214-109x(15)70010-0 · Cited by 66
Nationwide implementation of integrated community case management of childhood illness in Rwanda
Mugeni, C., Levine, A. C., Munyaneza, R. M., Mulindahabi, E., Cockrell, H. C., Glavis‐Bloom, J., Nutt, C. T., Wagner, C. M., Gaju, E., Rukundo, A., et al. (2014) · Global Health Science and Practice · doi:10.9745/ghsp-d-14-00080 · Cited by 66
A review of CARE’s Community Score Card experience and evidence
Gullo, S., Galavotti, C., & Altman, L. (2016) · Health Policy and Planning · doi:10.1093/heapol/czw064 · Cited by 66
Perry, H. B., Rassekh, B. M., GUPTA, S. K., Wilhelm, J. A., & Freeman, P. A. (2017) · Journal of Global Health · doi:10.7189/jogh.07.010901 · Cited by 63
Dahn, B., Woldermariam, A. T., Perry, H., Maeda, A., Glahn, D. V., Panjabi, R., Merchant, N., Vosburg, K., Palazuelos, D., Lu, C., et al. (2015) · doi:10.13140/rg.2.1.4865.0086 · Cited by 61
Omer, K., Mhatre, S., Ansari, N. M., Laucirica, J., & Andersson, N. (2008) · Patient Education and Counseling · doi:10.1016/j.pec.2008.02.018 · Cited by 58
George, A. S., LeFevre, A. E., Schleiff, M., Mancuso, A., Sacks, E., & Sarriot, E. (2018) · BMJ Global Health · doi:10.1136/bmjgh-2018-000811 · Cited by 58
Self-citationSacks, E., Swanson, R. C., Schensul, J. J., Gleave, A., Shelley, K. D., Were, M. K., Chowdhury, A. M., LeBan, K., & Perry, H. B. (2017) · International Quarterly of Community Health Education · doi:10.1177/0272684x17738089 · Cited by 56
Self-citationAn implementation framework for household and community integrated management of childhood illness
WINCH, P. J. (2002) · Health Policy and Planning · doi:10.1093/heapol/17.4.345 · Cited by 54
Perry, H. B., Morrow, M., Davis, T., Borger, S., Weiss, J., DeCoster, M., Ricca, J., & Ernst, P. (2015) · Global Health Science and Practice · doi:10.9745/ghsp-d-15-00052 · Cited by 51
Self-citationMarcil, L. E., Afsana, K., & Perry, H. B. (2016) · Journal of Urban Health · doi:10.1007/s11524-016-0026-0 · Cited by 46
Scaling Accountability through Vertically Integrated Civil Society Policy Monitoring and Advocacy
Fox, J. (2016) · Figshare · doi:10.13140/rg.2.2.22977.35687 · Cited by 46
Story, W. T., LeBan, K., Altobelli, L. C., Gebrian, B., Hossain, J., Lewis, J., Morrow, M., Nielsen, J. N., Rosales, A., Rubardt, M., et al. (2017) · Globalization and Health · doi:10.1186/s12992-017-0259-z · Cited by 46
Self-citationHoffman, S. J., Røttingen, J., Bennett, S., Lavis, J. N., Edge, J. S., & Frenk, J. (2012) · Cited by 44
Langston, A., Weiss, J., Landegger, J., Pullum, T., Morrow, M., Kabadege, M., Mugeni, C., & Sarriot, E. (2014) · Global Health: Science and Practice · doi:10.9745/ghsp-d-14-00067 · Cited by 35
Self-citationHodgins, S., Crigler, L., & Perry, H. B. (2018) · RePEc: Research Papers in Economics · Cited by 34
Underwood, C. R., Boulay, M., Snetro, G., Macwan’gi, M., Vijayaraghavan, J., Namfukwe, M., & Marsh, D. (2013) · International Quarterly of Community Health Education · doi:10.2190/iq.33.2.b · Cited by 28
George, A. S., Scott, K., Sarriot, E., Kanjilal, B., & Peters, D. H. (2016) · BMC Health Services Research · doi:10.1186/s12913-016-1859-7 · Cited by 24
Self-citationRodríguez, D., Shearer, J., Mariano, A. R., Juma, P. A., Dalglish, S. L., & Bennett, S. (2015) · Health Policy and Planning · doi:10.1093/heapol/czv033 · Cited by 23
Mwabu, G. (2010) · Cited by 18
Systems Thinking for Health Systems Strengthening
de Savigny, D., Adam, T., & Mookherji, S. (2009) · doi:10.13140/rg.2.1.4720.4325 · Cited by 18
Global Evidence for Peer Support: Humanizing Health Care
Progress, P. F., & Nclr (2014) · Cited by 14
Governance and Service Delivery: Practical Applications of Social Accountability Across Sectors
Wetterberg, A., Brinkerhoff, D. W., & Hertz, J. C. (2016) · doi:10.3768/rtipress.2016.bk.0019.1609 · Cited by 8
A cross-sectional survey on ZIKV in Honduras
Rosales, A. C., Mayorga, A. Y., Arias, A., Franz, F., Thomas, J., Huddle, J., Soto, R. J., Haynes, M., Prado, M., & Cherian, D. T. (2017) · International Journal of Health Governance · doi:10.1108/ijhg-11-2016-0053 · Cited by 8
Self-citationImproving Aid Effectiveness in Global Health
Beracochea, E. (2015) · Springer eBooks · doi:10.1007/978-1-4939-2721-0 · Cited by 6
Horton, R. C. (2016) · The Lancet · doi:10.1016/s0140-6736(16)00679-6 · Cited by 5
Effectiveness in Primary Healthcare in Peru
Altobelli, L. C. (2015) · Springer eBooks · doi:10.1007/978-1-4939-2721-0_12 · Cited by 4
Uncivil and skewed language on civil society?
Sarriot, E., LeBan, K., Sacks, E., Sow, C., & Burgess, C. (2016) · The Lancet · doi:10.1016/s0140-6736(16)30731-0 · Cited by 1
Self-citation
Research works printed but not linked: 10
- International Conference on primary health care, 2018. Available: https://www.who.int/primary-health/conference-phc/
- Health systems global symposium, 2018. Available: www.healthsystemsglobal.org/
- Core group conference reports. Washington, DC; 2018. <https://coregroup.org/resources/conference-reports/>
- Institutionalizing community health Conference, Johannesburg, South Africa, 2016. Available: http://www.ichc2017.org/
- Murray C , Lopez A , Rodgers A , et al . Chapter 5: choosing interventions to reduce specific risks. Geneva, Switzerland: World Health Organization, 2002.
- Advancing community health across the continuum of care, 2015, core group, April 2015, presentation at the core group spring conference. Available: <https://coregroup.org/wp-content/uploads/media-backup/documents/Spring_Conference_2015/Spring_2015_GHPC_Booklet_Final.pdf>
- Sarriot E . Community health workers and health volunteers: leaving old debates behind. Huffington post. Institutionalizing community health conference Blog series. Available: https://www.huffingtonpost.com/entry/community-health-workers-health-volunteers-leaving_us_58da6bc5e4b04f2f079272f5 [Accessed 28 Apr 2017].
- Weiss J . 'CHW peer support groups: an alternative approach to supportive supervision lessons from the Rwanda. Kabeho Mwana child survival project. USAID presentation at the Integrated Community Case Management. (iCCM): Evidence Review Symposium, Accra, Ghana, 2014.
- . First global Ministerial conference on healthy lifestyles and noncommunicable disease control. Moscow, Russia World Health Organization; 2011. https://www.who.int/nmh/publications/ncds_policy_makers_to_implement_intersectoral_action.pdf
- Alma-Ata 40 Roundable group, 2018. implementing the Astana Declaration—What Alma-Ata taught us. health affairs blog. Available: https://www.healthaffairs.org/do/10.1377/hblog20181024.24072/full/ · DOI
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LeBan, K., Kok, M. C., & Perry, H. B. (2021) · Health Research Policy and Systems · doi:10.1186/s12961-021-00756-4 · Cited by 137
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Peer- and community-led responses to HIV: A scoping review
Ayala, G., Sprague, L., van der Merwe, L. L. A., Thomas, R. M., Chang, J., Arreola, S. G., Davis, S. L. M., Taslim, A., Mienies, K., Nilo, A., et al. (2021) · PLoS ONE · doi:10.1371/journal.pone.0260555 · Cited by 127
Ugwu, C. N., Ugwu, O. P.-C., Alum, E. U., Eze, V. H. U., Basajja, M., Ugwu, J. N., Ogenyi, F. C., Ejemot-Nwadiaro, R. I., Okon, M. B., Egba, S. I., et al. (2025) · Medicine · doi:10.1097/md.0000000000041535 · Cited by 138
Metadata
- Authors
- Sacks, E., Morrow, M., Story, W. T., Shelley, K. D., Shanklin, D., Rahimtoola, M., Rosales, A., Ibe, O., & Sarriot, E.
- Affiliations
- Johns Hopkins University (US)
- United States Agency for International Development (US)
- University of Iowa (US)
- Program for Appropriate Technology in Health (US)
- CORE Inc, Washington, District of Columbia, USA
- Independent Health Systems Consultant, Boston, Massachusetts, USA
- World Vision (US)
- Save the Children (US)
- Corresponding author
- Sacks, Emma
- Venue
- BMJ Global Health
- Publisher
- BMJ
- Published
- 2019-06
- Volume
- 3
- Issue
- Suppl 3
- Pages
- e001384
- ISSN
- 2059-7908 (ISSN-L)
- PMC
- PMC6591791
- OpenAlex
- W2952783822
- Cited by
- 203
- References
- 69
- Citations by year
- 2026: 32 · 2025: 30 · 2024: 36 · 2023: 28 · 2022: 27 · 2021: 34 · 2020: 15 · 2019: 1
- Type
- conference abstract
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ Global Health (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Funders
- USAID / Maternal and Child Survival Program (Cooperative Agreement AID-OAA-A-14-00028)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Systems and Practices
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Community Health and Development
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Systems and Reforms
- Keywords
- community health, health system strengthening, health for all, community health workforce, community-based care, social mobilization, health information systems, accountability, health care financing, Sustainable Development Goals, Almaty
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