Ubuntu – “I am because we are”. An African philosophy that emphasizes the interconnectedness and responsibility that we have to the communities that make us who we are. During my internship at a Family Justice Center in the United States supporting survivors of interpersonal violence, this philosophy was drilled into me every day as my colleagues and I sought to better the lives of victims of interpersonal violence by focusing on community-powered solutions that integrated care across non-profit, healthcare, and law enforcement partners. But I also saw how much of the burden of care coordination fell on the shoulders of community-based nonprofits, often underfunded, overworked, and under-recognized in the formal health system.

This burden is not sustainable or ethical, and points to a deeper leadership problem in healthcare. Many systems proudly declare their commitments to people-centered, community-engaged care and health equity, but too often, these values don’t translate into infrastructure. Instead, care for patients’ holistic needs is often reduced to pre-made lists of relevant non-profits handed to patients for them to figure out on their own. There’s no follow-up, no tracking, no accountability process to ensure patients’ needs, whether getting access to housing or food, are truly met. In effect, patients are referred out into the void.  At the same time, healthcare systems often neglect the voices and views of those in our communities, including nonprofits and patients who deal with these issues every day, so that they may raise their concerns.

This isn’t just a gap in care, but at its heart, it’s a leadership failure. True integration across healthcare, nonprofits, and public welfare services requires intentional strategy, resource sharing, and long-term relationship building. It also requires investment from health systems into nonprofit partners, as without financial or operational support, health systems are simply offloading complex cases onto under-resourced nonprofits to deal with and manage.

There are promising solutions, however. Closed-loop referrals, systems that let healthcare providers follow up and confirm whether patients access the community-based services they’re referred to, are already being used in places like North Carolina and through platforms such as Unite Us. These systems work best when paired with care navigators and the development of stronger, direct working relationships with community not-for-profit partners that understand the lived reality behind social determinants of health. However, this is not possible without leader’s prioritization of partnerships through formal agreements, co-location, and other financial and operational support.

These partnerships also require broader systems change and commitment from healthcare institutions, the government, and private insurers. The current mainstream funding models, specifically fee-for-service, incentivize high patient volumes over care coordination and people-centered care.  To advance our journey towards holistic care, Leadership must continue to advocate for value-based models that reward holistic care, as without it, hospitals will remain disincentivized from investing in the kinds of preventative, community-engaged programs that change lives for the better. Further, healthcare leaders may consider internal reallocation of funds or seeking external philanthropy to make these nonprofit partnerships viable

Some institutions have already started to move in this direction, such as Massachusetts General Hospital’s Center for Community Health Improvement, which engages neighborhoods in building a culture of health. However, these programs, while a step in the right direction, are still part of the exception in terms of the overall health landscape in the United States.

The nonprofits I worked with didn’t just offer support but offered trauma-informed care addressing fundamental issues of food, housing, and safety. They handled the complex, human parts of healing that health systems are often too rigid to manage, but we cannot continue to ask them to carry this work on their own. If we want to create truly integrated systems, we need healthcare leaders to practice Ubuntu and step up to build models of care that reflect our values, invest in community partnerships, and rethink our existing systems to recenter community at the heart of all we do.

Author

Zain Memon

_­Harvard College, Harvard University, Cambridge, MA

Declaration of interests

I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none