When Doctors Without Borders/Médecins Sans Frontières (MSF) wrapped up its COVID-19 response in Puerto Rico last September, it felt less like an end but a new beginning. That’s because we were able to hand over medical activities to Puerto Rico Salud, an organization created by members of the original MSF team who wanted to continue offering health services to vulnerable groups on the island. The COVID-19 crisis had exposed some of the chronic needs and systemic failures of the local health system, issues that require more sustained attention and collaboration with community-based organizations.