Atlanta group connects underserved community members to care, resources

Senge Ngalame poses for a portrait at Mercy Care Decatur Street in Atlanta on Wednesday, November 8, 2023. (Arvin Temkar /



Senge Ngalame poses for a portrait at Mercy Care Decatur Street in Atlanta on Wednesday, November 8, 2023. (Arvin Temkar /

Barriers to accessing care and the loss of health care services have led an Atlanta-based organization’s mission to reinvent health care system as we know it.

The Atlanta Regional Collaborative for Health Improvement (ARCHI) is a coalition of community based organizations that seeks to address barriers to accessing care for patients with chronic illnesses and unmet social needs, such as housing and hunger. ARCHI touts its effort as the first cross-sector collaboration of social and health services in Atlanta committed to improving health by addressing social determinants of health.

ARCHI’s first community resource hub opened in 2018, and ARCHI now has three community resource hubs in Chamblee, downtown Atlanta and Old Fourth Ward. ARCHI says that community resource hubs have resulted in lower blood sugar levels (A1c) and lower blood pressure, improved health screenings, reduced emergency department visits and increased access to care for patients.

Each community resource hub is operated to serve the unique needs of the community it is located in, with patients mostly experiencing chronic illness and unmet social needs, such as housing and food insecurity, that exacerbate their conditions.

The hubs are one part of ARCHI’s goal to “invert the burden” of the health care system. The concept seeks to take the stress of navigating seeking out health care resources and services away from patients and individuals, by created a system of care that coordinates and streamlines care rather than working in siloes.

Senge Ngalame, a community health worker at the downtown community resource hub, says that through her work with patients she focuses on diabetes and hypertension control.

“Yes, we’re trying to assist them, but we’re also trying to make sure their health is improving,” Ngalame said.

The program lasts for around six months, with patients getting connected to primary care services through Mercy Care, along with addressing other needs that impact their health, such as employment, housing and transportation.

Dr. Reed Pitre shows a tiny calendar on Thursday, June 22, 2023 at Mercy Care in Atlanta. He works with patients in need. His speciality is psychiatry. Dr. Pitre has dedicated his time working with low income patients, including the homeless. (Michael Blackshire/

Credit: Michael Blackshire

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Credit: Michael Blackshire

Every month, 13 to 15 partners that are members in ARCHI’s network come together to discuss available resources and services for patients in the community resource hub. During these sessions, partners also share data and discuss ways to ensure practices and policies that provide aid to patients are equitable.

Williams says this helps community health workers like Ngalame better serve their patients.

“We really make sure that the community health workers that are at each community resource hub have a personal point of contact, so it’s not like they just have a phone number for that organization,” Williams said.

Some partners include Saint Joseph’s Health Center/Mercy Care, a provider of medical and dental care to low-income and uninsured patients, First Step Staffing, Wholesome Wave and Hope Atlanta.

According to ARCHI, most of their patients are Black and reside in southern portions of Fulton and DeKalb counties, areas which the organization say have long been impacted by “centuries of racist policies such as redlining and lack of supportive infrastructure.”

Since opening, the hubs have serviced over 400 patients. Through data shared by ARCHI, the program has resulted in a 39% decrease in emergency room visits, with 86% of patients having lowered their blood pressure.

Additionally, 61% patients have lower their BMI (body mass index), a measure of body fat based upon weight and height, and 91% have been connected to nutritional education.

Santrella Brinkely, a native Atlantan, is a patient of the downtown community resource hub. After being diagnosed with multiple sclerosis and experiencing depression, Brinkley says that she was connected to ARCHI.

She says that she has been connected food resources and other services that have improved her health. It has also been easier navigating getting the services she needs.

“I like the fact that I get to be able to know staff and I communicate with the same person on a regular basis,” Brinkley said. “Everything has just been really swell from my own personal experience.”

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