Health
4 case studies
Community-governed health systems decouple care from fee-for-service fragility cycles and align providers with population health outcomes rather than treatment volume.
Theory Connection: Health case studies show how decoupling from fee-for-service (eliminating financial fragility) and community governance (high alignment) creates sustainable primary care systems with strong identity coupling.
Barefoot College
Barefoot College, founded by Bunker Roy, trains rural grandmothers as solar engineers, health workers, and teachers. The regenerative model: once trained, these 'Solar Mamas' return to their villages and train others. Knowledge flows in cycles, not one-way transfers. The approach has reached 96 countries, demonstrating pure human capital RCA.
- Trains grandmothers (wisdom + community trust)
- Solar, health, water, education programs
- Trainees become trainers
Cuba's Primary Care System
Cuba's primary care system achieves first-world health outcomes with developing-world resources. The consultorios (doctor-and-nurse teams) live in the neighborhoods they serve, providing preventive care and early intervention. Infant mortality rivals the US at a fraction of the cost. However, governance is entirely state-controlled—citizens have no democratic input, and doctors cannot practice privately. It demonstrates what's possible with aligned incentives, but raises questions about whether state control can substitute for community governance.
- Universal coverage (100%)
- Neighborhood-based consultorios
- Doctors live in communities served
Ontario Community Health Centres
Ontario's Community Health Centres (CHCs) provide team-based primary care to underserved populations. Unlike fee-for-service medicine, CHCs are funded by capitation (per-patient) and governed by community boards. This decouples care from volume incentives and aligns it with population health outcomes. The model has operated for 54 years, demonstrating sustainable community-controlled healthcare.
- Team-based interprofessional care
- Community board governance
- Capitation funding model
Partners in Health
Partners in Health, founded by Paul Farmer, Jim Yong Kim, and others, pioneered community-based healthcare delivery in the world's poorest settings. Starting in Haiti's Central Plateau, PIH proved that complex diseases like MDR-TB and AIDS could be treated in resource-poor settings using 'accompaniment'—community health workers who walk with patients through treatment. The model has expanded to 11 countries, training local staff and building sustainable health systems rather than extracting patients to distant facilities.
- Community health worker model
- 'Accompaniment'—not rescue
- MDR-TB treatment in poor settings