Abstract
Background: Health systems function as complex adaptive networks where institutions, professionals and citizens interact to maintain public health and social well‑being. The World Health Organization conceptualised six foundational building blocks: service delivery, health workforce, information systems, access to essential medicines, financing and leadership/governance. While these components provide a valuable framework for strengthening systems, they insufficiently account for community dynamics and citizens’ roles in co‑producing health. This article proposes the addition of a seventh building block, ‘People’, to formally recognize individuals, households and communities as active partners in generating and sustaining health outcomes.
Methods: A systems‑thinking approach was used to analyse the interplay between institutional structures and community engagement, drawing on implementation theories and empirical evidence from India. The article explores how mechanisms under the National Health Mission, such as Village Health Sanitation and Nutrition Committees and Health and Wellness Centres, operationalize people‑centred governance.
Results: Integrating ‘People’ as a distinct building block enhances accountability, equity and resilience by repositioning citizens as co‑creators rather than passive beneficiaries. Empirical observations from India demonstrate how community‑led governance and participatory platforms strengthen local health responses, particularly in vulnerable rural settings.
Conclusion: The proposed seventh building block, ‘People’, reframes health systems from institutional hierarchies into inclusive, democratic and adaptive networks. This reconceptualization is essential for addressing contemporary challenges, including pandemic recovery, climate‑related health threats and the accelerating expansion of digital health.