Shifting Power to Achieve Better Health Outcomes for All

3 min readJan 19, 2024

Despite increasing investments in and efforts for health equity, we are not achieving sustainable equitable health outcomes at scale. Traditionally, the power to decide how health investments are conceptualized, funded, designed, and delivered has been concentrated in the hands of funders and high-level decision makers. Growing calls for localization and decolonization of health aid acknowledge these power imbalances and are spurring efforts to shift leadership and resources to local actors and communities. For these efforts to move beyond a tick-box approach, the global health community must acknowledge and redefine the norms, policies, and practices that shape our development assistance system.

At JSI, we are using our more than 45 years of experience in collaboration with partners to advance a new vision for health investments. This is guided by our Reimagining Technical Assistance (RTA) initiative’s critical shifts, a framework that identifies changes needed to move to a more country-driven, coordinated, and equitable system that delivers higher returns on investments and better health outcomes for all.

These critical shifts were initially defined by government representatives, local and international implementing partners, funders, and community advocates in the Democratic Republic of Congo and Nigeria, and later refined and validated with representatives from 13 countries and three funders. The critical shifts framework calls for changes in how we:

  1. Set the agenda, fund, and partner — centering local leadership, sustainability, and mutuality in partnerships.
  2. Plan, design, and implement programs — emphasizing flexible and co-creative approaches that prioritize local resources, systems, and expertise, and support coordination, contextualization, and adaptation.
  3. Address inequity and manage power asymmetries — fostering systems and partnerships that drive feedback and learning, elevate community voices, and expose gender-based bias and inequities.

These shifts redefine relationships among funders, governments, local and international implementing organizations, communities, and individual users of services.

For JSI, a key element of these shifts is shaping how we collaborate with local partners. The USAID-funded Country Health Information Systems and Data Use (CHISU) program, led by JSI and a consortium, is working to strengthen organizational development of local partners in Indonesia for a stronger health information system. Indonesia is implementing its digital health transformation strategy with support from CHISU, and for this strategy to succeed, it is essential that the Ministry of Health has access to local partners that can provide technical assistance to subnational governments.

CHISU partners with Castellum Digital Indonesia (CDI), a local Indonesian organization, to help subnational governments achieve digital health transformation. CHISU is supporting CDI’s organizational development goals through capacity self-assessment; identification of capacity priorities; development of a capacity-strengthening action plan; and capacity-strengthening workshops. The support for CDI’s goals shifts power and resources to local partners and ultimately ensures the Indonesian government has long-term partnerships to facilitate the critical shifts needed to achieve better health outcomes.

At the Prince Mahidol Award Conference this year, we are sharing our RTA expertise during a session on Recognizing and Addressing Legacy Systems of Power and Privilege. Join us as Stephanie Watson-Grant, deputy project director of CHISU; Ratih Syabrina, director of CDI; Shameka Harmon, public health advisor with the U.S. President’s Malaria Initiative at USAID; and Chris Seebregts, founder and CEO of Jembi Health Systems (a CHISU partner) discuss localization challenges and opportunities that local partners are navigating and how best to apply RTA’s critical shifts.




JSI is dedicated to improving people’s lives around the world through greater health, education, and socioeconomic equity for individuals and communities.