Trust Is Not the Goal. It’s the Outcome

Why returning to our core mandates—and practicing trustworthiness over rhetoric—is essential for rebuilding global health systems

“Go back to your mandate.”

That simple phrase, shared during the Harvard Global Health Institute’s 3rd Annual Global Health Symposium, carried the weight of hard-earned truth. It came during a panel titled “Displacement and Disparities: Navigating Health Challenges Amid Conflict,” and it was less a reprimand than a call to integrity.

In the world of global health and humanitarian response, we’ve seen organizations quietly but steadily drift from their core missions. Not out of ambition. Out of absence. Ministries faltered. Governments left gaps. And so, as Petra Khoury put it, “We’ve all overflown to fill voids and vacancies… The caravan of two became a caravan of 100.”

If you’ve ever led a startup, you’ll recognize this pattern for what it is: scope creep. A focused mission begins to blur in the face of real human need. In business, the result is inefficiency and dilution. In global health, the stakes are higher. Scope creep doesn’t just stretch teams. It burdens frontline workers with responsibilities they were never trained or resourced to carry, responsibilities without authority and without adequate support.

The deeper issue isn’t lack of compassion or capacity. It’s that the system itself is unaligned.

“If PEPFAR funds HIV, we do HIV. If the donor funds polio, we do polio,” one speaker explained. “We show up in remote villages where no one has seen a health worker for 10 years and we only deliver two drops of polio vaccine, because that’s all the funding allows.”

This isn’t just inefficient. It’s heartbreaking. Communities carry a century of health needs. And yet, we respond with programs designed for vertical success, not human wholeness.

In a world that increasingly lacks trust, between governments and citizens, donors and implementers, institutions and the people they claim to serve, it is tempting to chase after trust as a goal. But trust cannot be engineered. It is not something we “build” through slogans or surveys.

Trust is what emerges when our actions are just, our communication is truthful, and our mandates are clear.

Which brings us back to Kigali.

Just days ago, over 50 African nations signed the Africa Declaration on Artificial Intelligence at the Global AI Summit on Africa. Backed by the Gates Foundation, with support from Qhala, Smart Africa, and Rwanda’s Centre for the Fourth Industrial Revolution (C4IR), the declaration affirms a commitment to data sovereignty, digital infrastructure, and local innovation. It also announces a $60 billion Africa AI Fund, a landmark effort to invest not just in tools, but in capacity.

In parallel, 3,500 people across 20 hubs from Chile to South Africa are participating in this year’s Health Systems Innovation Lab Hackathon. The challenge? To reimagine high value health systems through the lens of AI. Not to displace humans, but to amplify what is human: listening, consultation, learning, and reflection.

At a moment when foreign aid is increasingly politicized, and entire organizations face an uncertain future, we are reminded of something deeper: It is not trust we need to seek. It is trustworthiness we need to practice.

That means returning to our mandates. Saying no to projects that dilute mission and yes to those that align with local capacity. It means asking: Are we designing systems that meet the reality of people’s lives or the preferences of donors?

It also means shifting how we think about social and economic development itself. Not as charity. Not as intervention. But as accompaniment. As the shared work of helping communities build systems they own, sustain, and adapt long after we’ve gone.

The late Paul Farmer, who helped found the Program in Global Surgery and Social Change (PGSSC), reminded us that despair is a luxury we cannot afford. He showed us that moral clarity, even in broken systems, is possible. His legacy was built not on expedience, but on alignment between purpose and practice, values and action.

If we are to honor that legacy, and if we are to repair trust where it has been fractured, we must commit to something harder than any policy reform: a consistent, principled practice of trustworthiness.

Unity is not the absence of difference. It is the alignment of action around shared purpose. And in that alignment, trust is not something we declare. It’s something we earn.

Salim Afshar