This site presents a framework. It does not claim to know what that framework looks like where you are.
The principles here were developed through more than twenty years of integrative practice in one place, by people who know that place. We share them because we believe they point toward something real and replicable. What replication looks like in your community, your culture, your resource environment — that is work only you can do.
We offer the tree. The planting is yours.
The Clinical Framework
Fifteen primers. Start anywhere. Read in sequence or follow the thread that matters to you.
Why this framework exists
The execution gap, the Alma-Ata promise, historical clinical lineages as evidence, and the two algorithms that govern clinical reasoning. Five primers that establish the diagnosis before presenting the model.
Three pillars: strategy, integration, trust
Isolated care, inclusive care, and true integrative care. The arc from presenting condition to full recovery. Trust as a clinical variable, not a soft outcome.
The instruments every practitioner carries
The stress/diet/sleep triad. The patient capacity pyramid. Constitution as the variable that makes care genuinely personal. Health agency as the highest-order outcome.
The clinical confidence problem
Why technically skilled providers still fail patients by optimizing for the presenting instance rather than the full arc of recovery.
- 01 Start here Live
- 02 The Alma-Ata Declaration Live
- 03 The execution gap Coming
- 04 On historical medicine Coming
- 05 The two algorithms Live
- 06 Three models of care Coming
- 07 The hub — structural support for a dynamic model Planned
- 08 The arc of care Coming
- 09 Validation and the wandering problem Planned
- 10 Trust as a clinical variable Coming
- 11 Trust for administrators, clinicians, and NGOs Planned
- 12 Stress, diet, sleep — the triad Coming
- 13 The patient capacity pyramid Coming
- 14 Constitution — knowing the individual Planned
- 15 Health agency — the Stage 3 target Planned
- 16 The clinical confidence problem Coming
The Cooperative Model
The delivery structure that makes the clinical framework sustainable.
Why a cooperative
The structural argument for community ownership. What the insurance model gets wrong and why removing it from primary care changes everything.
How it works
Membership, the integrated care team, what most people need in a given year, and the four-tier payment structure that keeps care accessible.
The federated backbone
How local cooperatives connect through shared infrastructure without losing what makes them local. The principle that makes the model scalable.
How to get involved
Three doors: as a member, as a practitioner, as a community builder. The model is open. The invitation is genuine.
A Worked Example
What we know, because we built it.
Global Resonances
Places where existing conditions align with parts of this framework. Presented with what we recognize — and honest about what we do not know.
The following are not implementation guides. We do not claim to know what this model looks like in Rwanda, Brazil, or Thailand. We recognize conditions that rhyme with the framework. Local practitioners, communities, and policymakers are the only ones who can know what it actually means where they are.
If you see your community in this work, we want to hear from you.
Rwanda — cooperative health workers
Community health worker cooperatives with performance-based incentives and community-based insurance covering more than 90% of the population. The cooperative structure exists. The integrative clinical arc does not yet.
Brazil — the Family Health Strategy
41,000 transdisciplinary teams covering 120 million people. The community-embedded team structure maps closely to the integrative model. The arc of care framework is the missing layer.
Thailand — near-universal access at low cost
Comprehensive coverage for nearly the entire population at less than one US dollar per visit, anchored in community-based primary care. Proof that access can be achieved. The integrative clinical depth is the next question.
Uganda — cooperative healthcare exported
A cooperative healthcare model that did not exist in 1997 now serves tens of thousands through 70+ providers. Community ownership and cooperative governance proven in a low-resource setting.