Voluntary & Community Organisations: Not the Third but the First Sector of Integrated Care?

When Mari, a person with diabetes and mental health challenges experiencing homelessness needed care, the hospital could treat their immediate health challenges but couldn’t address why they kept returning. It was a small community organization, with deep neighbourhood knowledge, flexible funding, and trusted relationships—that provided the wraparound support that finally broke the cycle. This story, repeated countless times across health systems
worldwide, raises a fundamental question: Why do we refer to the voluntary and community sector (VCS) as the “third sector” when it’s often the first to respond, innovate, and reach those most in need?

Over the past decade, integrated care has evolved beyond coordinating medical services to embrace truly holistic, person-centred approaches that address social determinants of health. This shift has highlighted the essential role of voluntary and community organizations, yet their contributions remain undervalued, underfunded, and poorly understood within health systems. This special issue challenges that positioning, presenting evidence that the VCS may be better positioned than traditional health services to deliver the values and outcomes that integrated care promises