Moses Tetui
1,2,3* 
, Anna-Karin Hurtig
2 , Frida Jonsson
2 , Eleanor Whyle
4 , Joseph Zulu
4 , Helen Schneider
5,6 , Alison Hernandez
7,2 , The Chaminuka Collective
1 School of Pharmacy, University of Waterloo, Waterloo, ON, Canada.
2 Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
3 Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda.
4 School of Public Health & Family Medicine (SPHFM), University of Cape Town, Cape Town, South Africa.
5 School of Public Health, University of the Western Cape, Cape Town, South Africa.
6 South African Medical Research Council Health Services to Systems Unit, University of the Western Cape, Cape Town, South Africa.
7 Centre for the Study of Equity and Governance in Health Systems, Guatemala City, Guatemala.
Abstract
While there have been increased calls for strengthening community health systems (CHSs), key priorities for this field have not been fully articulated. This paper seeks to fill this gap, presenting a collaboratively defined research agenda, accompanied by a ‘manifesto’ on strengthening research and practice in the CHS. The CHS research agenda domains were developed through a modified concept mapping process with a team of 33 experts on the CHS including policy-makers, implementers and researchers from institutions in six countries: Uganda, Guatemala, South Africa, Sweden, Tanzania and Zambia. The process began remotely with brainstorming research priorities and concluded in a one-week workshop that was held in Zambia where priorities for strengthening CHS were discussed, grouped into domains, interpreted, and drafted into a collective declaration. Eight domains of research priorities for CHSs were identified: clarifying the purpose and values of the CHS, ensure inclusivity; design, implementation and monitoring of strategies to strengthen the CHS; social, political and historical contexts of CHS; community health workers (CHWs); social accountability; the interface between the CHS and the broader health system; governance and stewardship; and finally, the ethical methodologies for researching the CHS. By harnessing a set of diverse and rich experiences and perspectives on CHS through a structured process, a multifaceted research agenda and manifesto that transcend context, disciplines and time were developed. We posit this as an entry into greater debate and diversity in the field as we continue to find ways to strengthen research and practice in the CHS.