COMMONLY used metrics for assessing effective healthcare delivery include access, affordability and quality.
However, a no less fundamental yet often overlooked dimension is the social layer within health services: the webs of trust, collective action and accountability that bind patients, providers and communities. Such a health system goes beyond conventional structures — it is embedded in a broader social, cultural and relational fabric, operating within and beyond the individual-centric paradigm.
The recent public health crisis, particularly the COVID-19 pandemic, highlighted the importance of social cohesion as a key determinant of health. Studies show that communities with high levels of interpersonal trust and civic engagement experienced lower mortality and higher vaccine coverage, even after accounting for material resources. Conversely, those facing persistent health inequities—especially fragmented or marginalized communities—encounter systemic barriers to accessing care. The “social fabric” also shapes how health workers perceive their roles. Frontline providers in resource-constrained settings with stronger social support networks report lower burnout and a greater sense of purpose. In contrast, where health systems lack community engagement, patient-provider relationships often become purely transactional , undermining essence of compassionate care.
Therefore, efforts to strengthen health systems must extend beyond material inputs to intentionally cultivate socio-relational infrastructure. Community engagement, participatory governance and culturally competent care are not peripheral interventions — they are central to building systems that are just, responsive and resilient.
Health cannot be shaped by biomedical tools alone. It must be nurtured through trust, solidarity and social justice — a truth underscored by The Lancet Commission on Health Systems and Equity. This is not a utopian claim. Building and reinforcing the social infrastructure within health services is not optional — it is essential for achieving sustainable health for all.
One compelling example of this approach is the Violence, Injury Prevention & Disability (VIPD) Unit at the Health Services Academy. Since its inception in 2022, the unit has served as a national technical and research platform centering the needs of survivors of violence, persons with disabilities and trauma-affected populations in public health planning. Through data generation, capacity building and direct community engagement, VIPD’s work affirms that health is not just about service delivery — it is about restoring dignity and rebuilding trust where it has long been eroded.
To build health systems that are truly responsive, we must weave them into the social and moral fabric of society. This means anchoring care in trust, co-creating it with communities and recognizing that equity and empathy are not optional features — they are the very foundation of sustainable health for everyone.
—The writer is Assistant Professor and Director of the Violence, Injury Prevention & Disability Unit, Health Services Academy, Ministry of National Health Services Regulations and Coordination, Islamabad.
(eesha@hsa.edu.pk)
