Agreement in Vancouver: Strong Health Systems Can Protect the Poor and Promote Equity

Agreement in Vancouver: Strong Health Systems Can Protect the Poor and Promote Equity

{Dr. Carissa F. Etienne, Director of the Pan American Health Organization, addressing the Fourth Symposium on Health Systems Research in Vancouver, Canada. (Photo credit: Health Systems Global)}Dr. Carissa F. Etienne, Director of the Pan American Health Organization, addressing the Fourth Symposium on Health Systems Research in Vancouver, Canada. (Photo credit: Health Systems Global)

Strong health systems can protect the poor and promote equity. That was the resounding main message at the Fourth Global Symposium on Health Systems Research, held in Vancouver, Canada, just a few weeks ago.

Policymakers, practitioners, and researchers at the symposium agreed: marginalized communities in low, middle, and high-income countries confront daily challenges that impede their health and lives. So experts called for global leaders to learn lessons both from poor and rich nations to address the inequities that exist in all communities. But a few other important themes echoed throughout the four-day event. And they are worth noting.

We need better collaboration and creativity to sort complex obstacles

Virtually everyone at the symposium talked about this, during plenaries, organized sessions, poster presentations, in the hallways, and at the exhibitors' booths. Health systems continue to experience the failure of collective action. The global health community must work with policymakers, the private sector, civil society, and the media if we are serious about building resilient health systems that keep populations healthy while preventing and withstanding health shocks. Nobody put it more clearly than Davide Mosca of the International Organization for Migration, who said, "We are fooling ourselves if we say the health sector can achieve resiliency alone. We must work with others."

A topic that received plenty of stage time was "intersectionality" — academic speak for the implications of living in an interconnected, interdependent world — and the challenges that it poses to building health systems that are resilient and responsive to this reality.

Midori de Habich, Peru's former health minister, reminded us that "We must move away from disease shocks and look at political and economic shocks, which have devastating effects on health systems." In addition, health systems often fail to take into consideration human fluidity, an issue of timely importance given the unprecedented migrant crisis currently under way in many regions.

Christina Zarowsky of the University of Montreal said, "Throughout the week we have heard stories from Canada to Guatemala that showed being from a high-income country does not exclude people from marginalization, and that health and social justice are inextricably linked. We cannot seek to address one without the other. The struggles and concerns of indigenous and marginalized people in high income countries reinforce that we must challenge ourselves and others to work together and learn across all countries."

We need definitions and clear language

In a satellite session by the Leadership, Management & Governance project, funded by USAID and led by MSH, the preliminary results of a massive literature review found that there's often a big gap between evidence and practice. Why? Because, in part, researchers and practitioners have different ways of communicating and they use different information shared in different networks. The presenters also asked: What factors contribute to the lack of rigorous evidence for LMG's role in health systems performance? Again, part of the answer has to do with the lack of standard definitions for outcome measures. Even the term governance was questioned – we lack consensus regarding its elements and drivers of success.

Another striking point of disagreement in the session was that some felt that we don't really need evidence, or that qualitative evidence is sufficient, because we know intuitively that leadership and governance are important to the health system. But MSH says it is important to know both the "what" and the "how" as well as the results for implementation, accountability, and transparency.

One might argue that the most important definition for this group is that of a strong health system. While several frameworks do exist, they all focus on the "what," but not on the "how." Perhaps we ought to start researching and discussing how things can be done, not just what needs to be done.

A final word on language: because this was a gathering primarily of researchers — with language that could easily put non-academics to sleep — an initiative called Emerging Voices for Global Health is helping researchers share their findings in plain language.

We need more money

Not surprisingly, all this work is underfunded. While the symposium focused largely on how high-income countries can help developing countries build health systems that are more resilient and responsive, it was clear that, A) countries need to define their own research priorities rather than researching what donors pay them to research, and, B) more funding is needed for both research and program implementation.

"Funding access to quality health services and ensuring that patients are treated with dignity and respect can be quite a challenge in low-income countries when they are under huge pressures," said Sara Bennett, a professor at Johns Hopkins School of Public Health and Chair of Health Systems Global, an organizer of the conference. Symposium organizers called on global leaders to put more resources into building strong and resilient health systems, to help populations cope with health conditions like chronic diseases and to prevent, contain, and respond to infectious disease epidemics.

The next global symposium is going to be hosted in 2018 in Liverpool, with a theme yet to be announced. Let's hope that by then, the global health community will have moved the discussion from "we need to" to "we have done so."

More on MSH's presence at the Fourth Health Systems Research Conference in Vancouver

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