When public healthcare systems are discussed, attention often centres on doctors, hospitals and government policy. Image: Courtesy of: Dr Moses Haregewoyn
What Dr Moses Haregewoyn learned about health systems long before he was running one
When public healthcare systems are discussed, attention often centres on doctors, hospitals and government policy.
17-07-26 12:31
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Lifestyle
When public healthcare systems are discussed, attention often centres on doctors, hospitals and government policy. Image: Courtesy of: Dr Moses Haregewoyn
Public memory tends to organise itself around visible acts of leadership: the decision made in crisis, the institution founded, the policy enacted.
What it consistently undervalues is the leadership required to build the systems within which any of those acts can mean anything – the administrative infrastructure that connects policy to population, the operational foundations that determine whether a health system functions reliably or fails quietly.
Dr Moses Haregewoyn has spent his career in the second category of work.
His biography does not resolve into a single type. It encompasses decades of institutional administration, sustained academic engagement, ordained ministry, published scholarship, and the patient work of building an organisation that serves millions of Americans without most of them knowing it exists.
Understanding why that combination coheres requires understanding the question that has organised his working life from the beginning: who is a health system actually for, and what does it require to truly reach them?
The Formation
Dr Moses Haregewoyn was born in Ethiopia and built his professional life across the United States – Georgia, New Jersey, New York, Ohio – navigating institutions that were not designed with his circumstances primarily in mind.
His research on political refugees in the United States, published with Lambert Academic Publishing in 2010 and adopted as a social sciences textbook at several American universities, was not an abstract academic exercise.
It was a rigorous attempt to document what happens to people who arrive with need but without the social capital that formal systems assume they possess.
The question it asked – how do institutions receive people they were not designed for? – is the same question his operational career has been answering ever since.
His faith, which he has described as inseparable from his professional and academic commitments, brings a specific orientation to questions of institutional responsibility.
As an ordained priest and Secretary General of the Orthodox Church Archdiocese in New York, he applies the same framework to ecclesiastical and civic life: leadership is stewardship, and stewardship is accountability to the people the institution exists to serve.
His 2023 book, Leadership: An Incumbent of Faith, articulates that framework in terms applicable to any public institution – accountability not as a constraint on leadership but as its defining expression.
What the Institution Required
“AHS was founded upon a mission to support vulnerable children and families,” Dr Moses Haregewoyn has said.
The statement is simple and carries the weight of a career. It describes not a programme objective but an operating premise – the orientation that has guided 30 years of decisions about what AHS builds, how it builds it, and for whom.
As President of Automated Health Systems (AHS), he oversees an organisation that administers public health access infrastructure across effectively all 50 US states, in partnership with government agencies managing Medicaid, CHIP, Medicare, and related programmes.
AHS operates at the point where health policy meets the population it was written for – the eligibility systems, enrollment operations, and citizen support infrastructure that determine whether coverage reaches the people who need it.
Most of the people who depend on those systems have no idea AHS exists.
That invisibility is, in one sense, the measure of the organisation’s success: when administrative systems function as they should, the people they serve experience only the care, not the complexity behind it.
The Question South Africa Is Asking
South Africa’s National Health Insurance programme represents one of the most ambitious coverage expansion commitments in the world and one of the most administratively complex.
The challenge it faces – extending meaningful coverage to a population that is diverse in language, geography, and prior relationship to formal health systems, across a context where administrative capacity varies enormously between provinces – is not primarily a clinical or financial problem.
It is a governance problem, in precisely the sense that Dr Moses Haregewoyn’s career has been an answer to.
He does not have a South African solution to that challenge.
What he has is a methodology developed across thirty years of building administrative health infrastructure under conditions of comparable complexity – diverse populations, federal governance structures, varying state capacity, and continuous political change.
The methodology is not transferable as a model.
It is available as a framework: start with the population you are trying to reach, design the administrative system around their actual circumstances rather than the circumstances the system finds convenient to assume, and build accountability into every layer of the operation.
That is, at its core, what AHS has done for nearly five decades.
It is what Dr. Haregewoyn has spent his career demonstrating is possible.
The question of who health systems are built for is not rhetorical.
It requires a practical answer, built into the architecture of the system itself. He has been working on that answer for a very long time.
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