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Drinking together - and fixing health systems


Photo of Sara BennettAccording to Wikipedia the term symposium comes from the Greek word “sympotein”  - to drink together. More than 1000 people are on the point of packing their bags and boarding planes to head to Montreux, Switzerland for the First Global Symposium on Health Systems Research.....they clearly have more than a quick communal drink in mind. But, as a seasoned participant in these grand global meetings it is difficult to prevent the wisps of cynicism from creeping into my mind: what difference do these big meetings really make? Will this just be another talking shop for those who can afford airfare and expensive Montreux hotel rooms?

So, what can and should the Symposium try to achieve? I have three big “asks” from the Symposium, but would be interested to hear what you want out of this meeting too.

First, the main theme of the Symposium is Universal Health Coverage, and the meeting is perfectly timed to lead into the launch of the 2010 World Health Report on Universal Health Coverage . Having got a sneak preview of this, I can testify that it is well worth reading. Moreover this is an agenda that every health person I know is passionate about. It would be great to turn the Symposium into the launch event for a really serious push towards extending basic health services to all – an issue that researchers, policy-makers and advocates could all get behind.

Second, health systems research is typically very applied, and its value comes from its application to policy and decision making. Over the past decade there has been an increasingly exciting movement to systematize the way that we go about linking evidence-to-policy. I have bemoaned elsewhere the fact that funding for this kind of bridging and knowledge translation work too often slips between the cracks. It would be great if the Symposium served to show case this work, help it step into the limelight and receive the type of support it deserves.

Third, my personal pet issue – research capacity for learning health systems. A recent paper estimated that there were 13,000 health service researchers in the US, compared to our estimate of about 6-7,500 in all low and middle income countries combined. We desperately need more skilled people across low and middle income countries to help analyse and steer health systems, and more strong research organizations to accommodate them. The best prospects for achieving this seem to be a fundamental shift in how many development agencies do their work so that they seriously support local institutional capacity development, particularly by providing core funding to the think tanks, research organizations and institutes in developing countries that conduct health systems research.

There looks like there will be a lot of great sessions at the Symposium: colleagues Gerry Bloom and David Peters from FHS are organizing sessions on Beyond Scaling up and on Evidence to Improve Health Service Delivery – which speak particularly to the theme of extending basic health services. I will be participating in a plenary session on research capacity development.

And what if the “Symposium” does not live up to our expectations? Well, maybe we can find solace in the original meaning of the term. I do happen to know a cozy bar in Montreux where perhaps we can take a drink together and debate what is really needed to fix health systems.

Welcome to our blog!

Woman with her child in ChinaThe Future Health Systems Consortium is a partnership of organisations conducting research in Bangladesh, China, India, Afghanistan and a range of African countries in order to improve health service delivery and health systems. We have a website where you can find more information on the organisations involved and download many of our publications.

Future Health Systems has started this blog so that we can provide swifter updates on what's happening in our worlds. We will use it to provide feedback from conferences, let you know when new reports and papers are out, participate in conversations about the challenges that we face in our work and solicit your ideas.

Feel free to get in contact or share your views.

Challenges for the future of primary care


It is thirty years since the Alma Ata Declaration outlined an international consensus on the need to provide universal access to primary health care (PHC). During the ensuing years some countries established well-organised government health services in which PHC played an important role. Many others were less successful. The lead up to our session at the Geneva Health Forum on future health systems provides a moment to reflect on some of the new challenges for PHC.

National governments and the international community are renewing their efforts to expand access to PHC and they have committed a lot of money for this purpose. But there have been many major changes in these last three decades that pose big challenges for the future of PHC. The drafters of the Alma Ata Declaration drew largely on the experiences of those post-revolutionary and post-colonial regimes, which were rapidly overcoming a lack of health facilities, health workers and drugs.

Whilst some remote areas still lack health services many settings have both trained and untrained people, providing health care and selling drugs. The boundary between public and private sectors is blurred and government health workers frequently ask for informal payments or see patients privately. Many of these activities occur outside an organised, regulated framework of health care provision. Potential users are much more likely to live near a health facility or some kind of provider than 30 years ago, but now they face major challenges in paying for care and finding competent providers and effective and appropriate drugs.

PHC was designed to deal with prevention/health promotion and with infectious diseases associated with poverty, poor sanitation and certain insect vectors. Although these illnesses persist, there is growing pressure on health systems to address other problems. One dramatic change has been the transformation of HIV infection into a chronic and progressive disease for which people can claim entitlement to treatment. People are also affected by other chronic conditions, associated with ageing and “lifestyle” changes. This raises difficult questions about which treatments are appropriate, who should pay for them and how health systems should be organised to help people manage long-term conditions.

Concern is growing about the potential threat of epidemics of new diseases or organisms resistant to the available drugs. Recent examples are SARS, multi-drug resistant tuberculosis and a possible influenza pandemic. Government responses rely heavily on convincing people to report suspicious outbreaks and cooperate with public health measures they may perceive to be against their short-term interest. This requires high levels of trust between the population and their health system.

More actors are involved in health systems than thirty years ago, including a variety of private providers of health-related goods and services, national and international NGOs, citizen advocacy groups and political parties (where competitive electoral politics have been introduced). Governments are seeking new ways to influence health systems with their powers to allocate money, enact and enforce laws and publish information. This sometimes involves new types of partnership for service delivery and regulation.

Finally, there have been dramatic developments of new technologies for diagnosis and treatment of disease, which influence the design of health systems. In addition, the rapid changes in information and communication technologies are having a big impact. Providers and users of health services increasingly have access to the mass media, mobile telephones and the internet. They carry health information produced by governments, professions, citizen advocacy groups and private companies. In contrast to 30 years ago, when health professionals were the major source of expert knowledge, people have a variety of sources from which to find information.

The anniversary of the Alma Ata Declaration provides a good opportunity to reaffirm national and international commitments to expand access to PHC. But, it is important to understand the changed context when formulating strategies for achieving this. Many innovations have emerged that involve quite different roles for governments, markets, civil society and individuals than the drafters of the Alma Ata Declaration envisaged. We need to find ways to involve all actors in an intensive process of innovation and learning if the latest statements of good intentions are to be translated into major improvements for poor people.

Editors note: This blog originally appeared on the STEPScentre blog, The Crossing.

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