From Consultation to Partnership: Leadership for Patient, Family, and Community Engagement in People-Centred Health Systems in LMICs: A Narrative Review

Abstract

Abstract People-centred health systems depend on more than inviting patients, families, and communities to provide feedback. Meaningful engagement requires opportunities for people to influence decisions and healthcare organizations that can respond to their priorities. This structured narrative review used targeted searches of PubMed-indexed literature and World Health Organization sources to identify relevant reviews, health-systems studies, and recent evidence. The synthesis focused on leadership approaches that support a shift from one-way consultation to meaningful partnership in low- and middle-income countries (LMICs), drawing on literature on community participation, patient and public involvement, co-creation, social accountability, and people-centred care. The literature indicates that partnership is more credible when leaders create inclusive representation, share decision-making, allocate time and resources, clarify accountability, and close feedback loops by showing how community input affects services. Common barriers include hierarchical decision processes, limited institutional capacity, unequal opportunities to participate, communication gaps, and poor follow-through on feedback. Drawing these findings together, this review proposes the LISTEN leadership framework: Listen, Include, Share Decisions, Train and Resource Participation, Establish Accountability Loops, and Notice Equity and Outcomes. The framework is presented as a practical synthesis rather than a validated instrument. People-centred leadership should therefore be assessed not only by whether patients and communities are invited to participate, but also by whether their involvement influences decisions, strengthens trust and responsiveness, and contributes to more equitable and higher-quality health systems.