“In 25 years, you should be irrelevant.”
With those words, Volante CEO Liz Jarman hushed the room at VillageReach’s 25th anniversary event.
The point was clear: if nonprofits are still needed to fill gaps in health systems decades from now, we’ve failed. While we can catalyze innovation and take risks, real success means governments and communities leading their own health futures without external support.
Another organization marking 25 years in 2025, the Gates Foundation, has gone further: setting an end date for all operations, 2045. They recognized that accelerated investment over a fixed horizon can drive change, but that an endpoint provides focus.
Durable health progress requires patience and a vision that extends beyond the next grant cycle.
Innovation That Lasts with Community Insights to Action
Public health crises, from Ebola to COVID-19, have revealed the high cost of quick fixes and fragmented investments. Too often, new pilots emerge with urgency, only to fade away due to a lack of integration into health systems. Innovations last when they respond to communities’ lived experiences and governments’ priorities. Responsiveness means not just chasing symptoms; it means building systems that can listen, adapt and endure.
The health system can only work for the people if it listens to them.
That’s the heart of the Community Insights to Action (CITA) approach. Instead of designing solutions from the top down, CITA begins by asking communities—especially those that are often overlooked—what matters most to them. Their answers shape how services are delivered, how policies are made and how programs are planned.
But it doesn’t stop there. CITA closes the loop by showing communities how their voices led to real change. That feedback builds trust, strengthens accountability and keeps the conversation going.
It’s not just a method; it’s a mindset shift that puts people at the center of the systems that serve them, and it is innovative by design. CITA ensures that health systems do not stagnate but are continually refreshed with new ideas and better ways of doing things, grounded in the realities of those who are most often excluded.
Why Responsiveness Matters Now
Responsiveness means that health care is available when and where it is needed, that it can adapt to shifting demands, absorb shocks and reflect the priorities of the people it serves. This matters more than ever at a time when health budgets are shrinking, donor contributions are unpredictable and governments must make hard choices about limited resources. It matters because inequities are widening, with those living farthest from health facilities, migrants and marginalized groups excluded from the health care gains of the last 50 years. And it matters because our systems face increasing shocks from pandemics, climate disasters and displacement that require flexibility rather than rigidity.
Yet the current financial environment pushes in the opposite direction. When funding reduces, horizons often shrink. Donors and governments alike can be tempted to prioritize projects that show fast results but have no path to sustainability. This leads to duplication of effort, wasted resources and initiatives that vanish when funding ends.
It is more important than ever to resist the trap of quick fixes and invest in approaches that last.
Practical Philosophy Rooted in the Hardest Places
VillageReach itself was founded in Mozambique in the aftermath of Cyclone Eline in 2000. From the beginning, its philosophy was to design for the lowest-resource settings first, because if it works there, it can work anywhere.
That founding principle still holds true today, especially in how we engage with communities most often left behind, including women without safe maternity care, rural families facing vaccine stockouts and young people cut off from reliable health information. From this starting point, CITA builds system responsiveness step by step: engaging deeply with communities, analyzing insights, translating them into system-level action, embedding them into government processes and closing the loop.
Over time, systems become not just stronger but more innovative. But this is not a quick fix.
No Shortcuts in System Design
We have found that complete system design through to closing the loop with communities takes longer than the 6–12 month time horizon of most programs. It takes time to reach marginalized groups in local languages and through trusted intermediaries. It takes time to move from feedback to transformation. It takes time to equip health workers and managers to lead and integrate their good practices into existing systems. And it takes time to return to communities to show how their input has shaped change.
This deliberate pace has clear payoffs. In Mozambique, when a nationwide vaccine stockout left many mothers anxious, the AlôVida hotline, where a CITA lens is being applied, became a lifeline. A WhatsApp innovation allowed women to ask questions, seek reassurance and demand answers. In the DRC, CITA data helped prioritize when and how to implement “special vaccination strategies” in hard-to-reach areas to improve uptake where it was most needed. Over the past five years, this community-driven Next Generation Supply Chain in the DRC has brought half of the country’s provinces from the bottom tier to among the best performers in vaccine availability. The progress was not the result of rushing but of steady, iterative improvements aligned with time-bound government priorities.
The lesson is that we must plan for decades, but within those horizons set milestones that compel progress.
Building to Last
Responsive systems reach those who have been previously left behind. They are more resilient because they can absorb shocks and maintain continuity. They are more trusted because people see their voices leading to action. And they are more innovative because feedback, action and accountability spark new ideas across the system.
In moments of uncertainty, the temptation is to prioritize speed. But the real need is for patience to embed responsiveness into core systems and build sustainable government ownership. Funders, governments and implementers must resist short-term thinking and commit instead to approaches that are routine, responsive, iterative and designed to last. By reducing duplication and building trust, we can deliver better results for every dollar invested.
The right question is not “how fast can we do it?” but “how well can we build it—and how soon can we begin?” Africa has the talent, the will and the innovations. What we—governments, funders and implementers—need now is the patience and focus to build health systems that endure.
