Helen Schneider
1* 
, Jill Olivier
2 , Marsha Orgill
2, Leanne Brady
2 , Eleanor Whyle
2 , Joseph Zulu
3 , Miguel San Sebastian
4 , Asha George
5 , The Chaminuka Collective
1 SAMRC Health Services to Systems Research Unit, School of Public Health, University of the Western Cape, Cape Town, South Africa.
2 School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.
3 School of Public Health, University of Zambia, Lusaka, Zambia.
4 Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
5 School of Public Health, University of the Western Cape, Cape Town, South Africa.
Abstract
Community health systems (CHSs) have historically been approached from multiple perspectives, with different purposes and methodological and disciplinary orientations. The terrain is, on the one hand, vast and diverse. On the other hand, under the banner of universal health coverage (UHC) and the Sustainable Development Goals (SDGs), a streamlined version of ‘community health’ is increasingly being consolidated in global health and donor communities. With the view to informing debate and practice, this paper seeks to synthesise approaches to the CHS into a set of ‘lenses,’ drawing on the collective and multi-disciplinary knowledge (both formal and experiential) of the authors, a collaborative network of 23 researchers from seven institutions across six countries (spanning low, middle and high income). With a common view of the CHS as a complex adaptive system, we propose four key lenses, referred to as programmatic, relational, collective action and critical lenses. The lenses represent different positionalities in community health, encompassing macro-level policy-maker, front-line and community vantage points, and purposes ranging from social justice to instrumental goals. We define and describe the main elements of each lens and their implications for thinking about policy, practice and research. Distilling a set of key lenses offers a way to make sense of a complex terrain, but also counters what may emerge as a dominant, single narrative on the CHS in global health. By making explicit and bringing together different lenses on the CHS, the limits and possibilities of each may be better appreciated, while promoting integrative, systems thinking in policy, practice and research.