Last week the Cape Town International Convention Center was filled with almost 2,000 participants from 125 countries talking about health systems. The Symposium theme was the Science and Practice of People-Centered Health Systems, and the dialogue was bigger and broader than the somewhat academic vision that the “Third Global Health Systems Research Symposium” might evoke.
With two full days of satellite events, three days of dozens of concurrent sessions, and four information-rich plenaries (that you can still watch in full), the Symposium was rich in content, involved a huge variety of people, and had plenty of spirit and opportunities to build coalitions for better health systems. Sifting through the volume of information from sessions, marketplace discussions, and hallway chatter, here are our key takeaways from #HSR2014:
- Health systems need to be reoriented to address people’s needs first, focusing on equity and addressing power relationships that undermine the achievement of universal health care. This means putting citizens, local actors (governments, organizations, and leaders) in the forefront of decision making and making systems responsive to expressed and latent local needs.
- Researchers and implementers need to network, connect, and collaborate more closely. To drive health system change, policy makers, implementers, and researchers need to join forces more effectively. Collaboration combines the objectivity that research can bring (and was so vehemently defended by some attendees and panelists), while making sure information that is collected is grounded in practice and focused on problem solving and learning that implementers need to improve health.Together, we need to ensure that the learning is used routinely to inform policy, program design and management in real time (when possible) rather than waiting for publication deadlines. Implementation science, realist evaluation, and developmental evaluation offer powerful frameworks for facilitating this collaboration and practice-oriented research.
- It is essential to translate research into actionable information. Publishing in a peer reviewed journal seldom puts findings in the hands of the people who need it for decision making. In order to encourage policy makers and implementers to use research to inform their work, we must make sure findings are promoted in accessible, inviting ways.
- People-centered means seeing all actors in the system as people: clients, providers, and policy makers. Depending on who we talked to, the perception of who the key actors in the system are was slightly different: some, with clinical training, though immediately of the health workers, while others focused on the clients the health system ultimately needs to serve. To take a holistic approach to people-centered health systems strengthening and research, we must consider the needs of all actors, taking into consideration that many act in multiple capacities (as clinician, strategic manager, and coach, for example). The call for better tools to understand the complexity of actors, institutions and their interaction is a good one.
- We need to draw from new or atypical public health disciplines to improve how we understand the needs of the people we aim to serve through strengthened health systems. These range from participatory action research (PAR) to human-centered design. Tools like user personal development can be used beyond product design and photo voice brings user perspectives to the dialogue. Drawing on innovative methods across disciplines can help implementers, researchers and evaluators build our toolbox to understand the users of the system, explore questions that matter not only to donors but to the district medical officers in the field, and feedback out findings in meaningful ways that get used by those who matter.
- Calling out the value and potential of routine health information in building effective health systems. Few discussions this week focused on the need for strengthening routine health information systems (RHIS), which are often the primary source of health data for district health managers and other key stakeholders. But only some touched on the value of RHIS data, suggesting it deserves much more attention and credit than it currently receives. In most countries, health staff across the systems are required to spend the time at least monthly aggregating, submitting, reviewing, and analyzing reports from DHIS and other information systems.By focusing on building capacity to use the data already in those systems, improve the data quality, and visualize that information in actionable ways, we can promote evidence based decision making while strengthening an essential building block of the health systems. Without promoting and sharing about evidence-based approaches to RHIS strengthening, we miss out on an opportunity to promote a sustainable and locally-driven means of generating information.
You can also read this more robust Cape Town Statement on the themes and takeaways from the Symposium that has been published by the organizing body, Health Systems Global.