Global health can be defined by its years. 2015 was the year of the Sustainable Development Goals. 2019 was the year global leaders adopted the UN Declaration on Universal Health Coverage (UHC). 2020 was the year COVID-19 was declared a Public Health Emergency of International Concern.
We are not far away from 2030, the year we declared we would achieve UHC. And yet, in 2025, global health is in flux, battling against shifting priorities and reduced spending that threatens to reverse decades of progress in the race towards health for all.
While the state of global health is up in the air, our collective goal must not change. Now is the time to focus on a targeted approach to reaching UHC. To ensure that everyone has the health care needed to thrive, we must reach everyone, especially the hardest-to-reach communities.
Now is the time to make health care responsive to the needs of all.
A Push for Responsive Health Systems
Responsiveness has been identified as one of the most important goals of health care systems. When health systems are responsive, they anticipate and adapt to existing and future health needs, and by doing so, contribute to better health outcomes.
What can be done to make a health system more responsive? It must include the communities that are impacted by incorporating their needs and preferences into intervention design and delivery. It can also be through technological advancements in the digital health space, improving access to health care information for the hardest-to-reach communities. And finally, it can be through improving the public health supply chain, ensuring that essential medicines and vaccines reach the last mile.
These small but necessary steps help us transform health care delivery, reducing health inequities to create health systems that meet the future and current needs of populations.
Building Trust in Communities
The center of the health system lies in the community. Working with and involving communities in health system design, routinely integrating their insights and data, ensures that the needs and preferences of communities are factored into primary health care service delivery every single day.
This also helps foster trust between communities and health facilities, and even more so, patients and providers. Fostering trust in the health system is a critical part of developing quality, people-centered care.
Programs such as Let’s Talk About Vaccines in Mozambique and Malawi prioritize caregiver and health worker voices to address barriers to routine immunization in children under two, creating and implementing community-defined solutions. This increases immunization rates in communities, strengthens community engagement in immunization, and enhances caregivers’ experiences with vaccination services by improving accessibility, timeliness and vaccine availability.
By employing community-based participatory methods, immunization programs and other health care services can develop solutions that are more responsive to the needs of the communities they serve.
Digitizing Health for Accessibility
In a rapidly growing and changing world, technology should also be leveraged appropriately when developing responsive health systems, especially as it continues to transform the global health landscape. The World Health Organization’s global strategy for digital health explicitly calls for the application of digital health technologies to support the vision of health for all, with these initiatives integrated into a country’s health strategies.
Countries such as Malawi and Mozambique have already made the push towards integrating responsive digital health innovations into their health systems, with Malawi’s Chipatala cha pa Foni (CCPF), a government-run nationwide health hotline, providing free information on health and nutrition to all Malawians 24 hours a day, 7 days a week. This includes the needs of those in the hardest-to-reach communities, providing them with information on health care that is tailored to their needs and preferences. Mozambique’s AlôVida also utilizes WhatsApp to offer health information and services across different languages.
Telehealth innovations such as CCPF and Alôvida, integrated seamlessly at both the local and national level, help overcome barriers like geographic isolation and workforce shortages to reach people when and where needed. Health systems become more responsive when they adjust to the context in which they exist – whether at local level, by offering services in different languages, at the health facility level, by connecting people to health providers where need, or at the national level, by utilizing the most widely used messaging app in Africa to increase access and availability to vital health information.
If we can routinely respond to the needs of the hardest-to-reach people, we can respond to the needs of everyone.
Strengthening the Supply Chain to the Last Mile
To reach everyone, we must bring responsive health care to the last mile. Studies have found that rural communities in low- and middle-income countries continue to face health care delivery and access problems. These gaps in access can be addressed by strengthening a fundamental yet often overlooked part of health systems – the supply chain.
The public health supply chain provides linkages between health facilities and communities and by building upon existing supply chains so that they better respond to people’s needs, we can ensure that both essential medicines and vaccines reach communities and health care workers, community health workers in particular, provide more consistent access to quality health care.
In the Democratic Republic of Congo, the Next Generation Supply Chain (NGCA+) supplements the existing health supply chain by using innovative delivery methods such as drones and private-sector transporters. It also provides community health workers with the knowledge and resources they need to effectively immunize and treat community members, thus increasing immunization rates and simultaneously reducing outbreaks and the spread of diseases.
In fact, strengthening and professionalizing community health workers, a vital part of the public health supply chain workforce, brings us closer to a truly responsive health system. In geographically isolated areas far from health facilities, community health workers are the closest connection to health care for patients, as they administer routine immunization for children and educate caregivers about health topics. They are critical in responding to the needs of under-reached people and addressing immunization equity.
Redefining the Future as Responsive
Let us redefine 2025 by building systems that adapt to existing and future health needs, no matter where a person lives. Responsiveness is a two-way street, a feedback loop that must integrate insights of the communities being served. By redoubling our resolve to reach UHC by 2030 through responsive health systems, we can transform health care for everyone.