INTRODUCTION:
Societal engagement and collaboration are essential to dismantling systemic inequalities and power imbalances. Beginning at the grassroots, empowering patients and communities to identify priorities, participate and influence service delivery, and advocate for effective responses strengthens primary healthcare systems through power realignment and shared ownership. Médecins Sans Frontières has partnered with communities, grassroots organisations, and Ministries of Health to support sustainable, context-appropriate healthcare access that respects local practices and centres community agency.

METHODS:
This multi-disciplinary community engaged approach has been implemented across diverse settings in South Africa, Malawi, Zimbabwe, Mozambique, Kenya, and India. Context-specific strategies were co-developed, and support was provided to patient groups, community organisations and stakeholders. Implementation focused on community-led governance measures, community-led service delivery, and representation of marginalised communities on healthcare platforms at different levels.

RESULTS:
Deliberate efforts to redistribute power to community organisations, patients, and local stakeholders through holistic capacity-building and strategic partnerships have significantly improved access to healthcare for marginalised populations. Community-based organisations, patient groups, and local leaders provide essential lay-health services beyond formal healthcare facilities. The deliberate inclusion of beneficiaries in decision-making processes has led to the formation of community advisory boards that influence MSF project activities and strengthen patient representation within Ministry of Health advisory structures. Community actors developed sustained linkages with MoH partners, NGOs, and civil society networks, enabling collaboration, peer learning and collective advocacy. These efforts resulted in context-specific, community-led health solutions that integrate indigenous knowledge, maximise local resources, and advance inclusive, equitable healthcare access.

CONCLUSIONS:
Addressing healthcare inequities requires participatory decision making that centres patients and communities. Community-engaged healthcare enables active involvement in service delivery while building capacity for communities to advocate for their priorities and solutions. This experience underscores the need for health systems to integrate locally driven initiatives grounded in community priorities, indigenous knowledge, and equal, collaborative partnerships.