What role can the commons play in improving citizen trust in healthcare services? We explore this question in the context of the chronic blood supply shortage in Botswana, where the Indigenous kgotla village governance system operates alongside the republican state. To address barriers to trust in the blood services ecosystem, we review the public-commons partnership model as a commons ecosystem model that could support participatory design of blood services between the kgotla and state. We apply this model to the ecosystem mapping tool used in the Jigsaw framework, a method previously used in Botswana to support ecosystem visualization, to prompt state consideration of this alternative public-commons partnership as a solution to the blood supply shortage. We also explore the re-visualized ecosystem as a pluriversal commons, where the kgotla and state cosmologies must interact to solve the collective action challenge of blood supply.