Transforming care from the territory: lessons from the LEADER model

Background: In Latin America and the Caribbean, there are educational, community, and public management experiences that demonstrate the capacity of transformative leadership to influence policies and social outcomes, as well as to advance integrated care and shared health governance among services, local governments, and communities. Building on this foundation, HENA developed the LEADER initiative: a roadmap toward an equity-driven action model that promotes leadership grounded in intersectionality, resilience, and community agency, recognizing change agents as facilitators of organizational and territorial transformations to integrate and co-manage health.

 

Approach: The roadmap for the LEADER model was developed through working sessions in HENA’s idea laboratories. A total of 16 sessions were held between November 2025 and July 2026 with participation from professionals in health promotion, epidemiology, public health, psychology, and medicine. The process identified the essential elements for a transformative leadership model that brings communities closer to health decision-making spaces and innovatively influences Primary Health Care, giving priority to community actors and organizations. It was proposed that LEADER be implemented through participatory action research, enabling the creation of a Community Participation Council where individuals can make decisions on issues directly affecting their health.

 

Results: The development of the LEADER roadmap identified key components of transformative leadership oriented toward equity and community-based care. Three interconnected dimensions stand out: intersectionality to understand and prioritize inequalities; community resilience as the engine of sustainability; and agency to strengthen the decision-making role of individuals and organizations.

 

These elements rebalance relationships between services and communities, reinforcing co-management, shared responsibility, and territorial coordination. Although the model is in progress, its formulation offers an operational framework for participatory action research and for establishing Community Participation Councils and deliberative spaces influencing local priorities. LIDERA offers a pathway toward holistic, inclusive, and sustainable care, fostering tools for community leaders to engage in decision-making spaces and enhancing autonomy and quality of life in communities.

 

Implications: The LEADER model provides valuable lessons on structuring transformative leadership processes with an intersectional and community-centered approach to health. Its development demonstrates that equity is not achieved solely by expanding services, but also by strengthening collective capacity to influence decisions shaping health and well-being. It is based on a participatory methodology linking action research with territorial governance, offering tools to translate community agency into sustainable decisions in Primary Health Care. LEADER contributes to rethinking care organization toward collaborative models where shared responsibility, autonomy, and participation are strategic drivers to improve outcomes and consolidate person-centered care grounded in community contexts.