While it may be fireworks that speckle the sky in celebration in some countries, it is the petrifying sight and sound of bombs in others – and with that (in addition to general loss of innocent lives) we continue to lose critical human resources in health – health care personnel with families and friends who need and love them, health care personnel with dreams and aspirations of their own.

As several countries celebrate their real (and perceived) freedom from colonial rule this July 1st, India commemorates its doctors – a cadre of health professionals whose contributions to individual lives and communities are celebrated on different days in various countries across the globe. In India, National Doctors Day is celebrated in honor of the physician, freedom fighter, and former Chief Minister of West Bengal Dr. B C Roy: July 1, 1882 – July 1, 1962.

On this day we remind ourselves of the many physicians in organizations who have sacrificed their own security and wellbeing to secure those of others. Of particular note are Physicians for Human Rights (PHR) with their efforts to protect medical facilities and personnel worldwide and Doctors without Borders (MSF) who deliver medical aid “to people affected by armed conflict, epidemics, healthcare exclusion and natural or man-made disasters.” Regardless of the numerous abductions and kidnappings through which MSF has suffered (Haiti in 2010, DRC in 2012, Syria in 2016, etc.), its physicians continue to dedicate their lives and careers to provide medical care to those afflicted with illness and injury compounded, oftentimes, by humanitarian tragedies.

It comes as no surprise then that the UN Security Council passed a resolution last month sending a strong message condemning attacks against health personnel and facilities in conflict situations. But what difference do these grandiose resolutions make? Who has the power in the present day and age to enforce peacekeeping or ensure moral discipline? When the rules of war are constantly being disregarded as if they were just simple inconveniences, what hope do we have for civilian and humanitarian efforts of safety for those caught in a political game of power and philosophical extremism? Perhaps it is organizations such as MSF that go beyond their medical duties to take political stances such as boycotting the World Humanitarian Summit; and rejecting money from the EU (in protest of EU migration policies).

While many may deride (some) physicians (especially in the “West”) for being attracted to what is clearly a profitable profession – frequently associated with golf club memberships, exotic vacations, and fancy cars (not forgetting malpractice lawsuits!) – let us recognize and celebrate those who use their training and expertise to serve humanity and ease suffering often at the risk of their own physical, financial, social, professional and familial safety. This is exemplified in experiences of individuals such as those of Dr. Nahid Bhadelia, who gives a powerful recount of the stigma and fear she faced on her return to USA after dedicating time and service to the Ebola outbreak in Sierra Leone, Dr. Salim Jivanji in the UK who performs voluntary cardiac surgeries in his home country of Kenya through UK based Healing Little Hearts, Dr. Sheila Lakhoo who has sourced funding to work with farmers in Kenya to reduce incidence of chronic diseases, and Dr. Zohray Talib who juggles strategies to strengthen medical education as well as health systems in low-resource settings with a focus on the global health workforce taking her to places such as Uganda and Tajikistan. She chronicles her experiences in her blog GlobalhealthMd. These are only but a handful of the thousands of doctors who exemplify the medical profession – people who are not only trained and licensed to treat sick and injured people, but who reveal an innate desire to serve with humility and to learn with curiosity.

With the world’s existing shortage of physicians, to lose more of these critical resources through no choice of their own, is particularly disastrous and clearly threatens the already dire situation of nations globally who struggle to meet WHO’s stipulated minimum ratio of 1 doctor:1000 persons. WHO’s Interactive map demonstrating the density of physicians in each country is evidence enough of this gloomy state of affairs. The potential solutions to this are beyond the scope of this piece and well documented in the literature and public commentary but suffice it to say that it is a problem that will continue to haunt us as long as we continue to lose lives that aim to save lives – the apt title of a recent CFR panel featuring Jason Cone, MSF; ICRC Director-General Yves Daccord; and Leonard Rubenstein, director of the Bloomberg School’s Program on Human Rights, Health, and Conflict.

So let’s all invoke another historic July 1^st moment: let’s all broadcast the international distress signal – SOS –  that was adopted on this day in 1908 and recognize doctors, nurses, public health professionals, and all other health care personnel globally who are fighting for social justice, humanity and dignity… SOS – save our (health care) soldiers. Save our (human) souls.

In last week’s New Leaders for Health (NL4H) Pre-Forum in Manila, four Emerging Voices alumni – three from Class 2014 (Renzo Guinto, Nasreen Jessani, Bhaskar Purohit) and one from Class 2012 (Beverly Ho) – participated in a panel entitled “Emerging Voices for Global Health: The Future of Health Systems Research.” The panel aimed to not only introduce the Emerging Voices for Global Health (EV4GH) program to young health researchers and innovators, but also to showcase the experiences of Emerging Voices (EV) alumni post-training and their visions for the future of health systems research across the world. We asked the four alumni to summarize in ten points the key messages that arose from their exciting ‘Manila conversation’ – and below are their answers:

1. Novel and innovative opportunities such as EV4GH help prepare the new generation of health system researchers for greater impact locally and globally. Many of the ‘soft skills’ essential to success in global health systems research are not taught inside the classroom – they require innovative approaches that allow peer-learning and ‘learning-by-doing’ modalities for example. The impact of EVs goes beyond conferences – for instance, because EVs were prepared on how to better package their research findings for evidence to policy translation, Bhaskar’s research on role-related stress among health workers in India and Bev’s study on health insurance coverage and healthcare utilization in the Philippines have been considered in policy development by government agencies and decision-makers. On the other hand, Renzo’s paper on migrant inclusion in universal health coverage in Southeast Asia has been cited several times by other researchers in articles and presentations. Clearly, programs such as EV4GH both enhance traditional presentation skills (i.e. posters and lectures) and develop contemporary public outreach skills (writing blogs and op-eds), among others. More capacity-building programs that are both innovative and impact-oriented are therefore encouraged to complement traditional education in schools of public health.

2. Posters should be in no way treated as inferior to oral presentations. Posters are essential and effective ways of communicating research to the scientific community. Often however, researchers are guilty of copying and pasting bits and pieces of their manuscripts into the poster, and of not seeking help even for seemingly minor aspects such as font, color, layout, and photos. During the EV4GH program, we alumni have witnessed how our posters dramatically evolved and transformed from Day One to poster session day. In fact, during the Third Global Symposium on Health Systems Research held in Cape Town last year, EV4GH 2014 alumni won in the poster competition in 2 out of 3 days – up against tenured researchers some of who had been creating posters for over 30 years! The EV4GH program enhanced our skills in creating powerful scientific posters for conferences – not just for the prizes as demonstrated earlier, but also for capturing the attention of interested colleagues and target audience. For instance, Renzo recalls how he got connected with fellow Southeast Asian researchers as well as enthusiasts in migrant health who visited his poster in Cape Town. Nasreen’s poster on the use of social network analysis (SNA) to identify key knowledge brokers in linking research to policy led to requests for her to conduct workshops on SNA at the ResUpMeetUp symposium in Kenya and the NL4H Pre-Forum in the Philippines.

3. It is important to distinguish advisors from mentors. Oftentimes, we come across well-established and impressive professionals who are willing to provide advice but have neither the time nor the inclination to provide constant support to aspiring early careerists. During the panel discussion, we urged participants to look for people who have a stake in their success: those who are willing to walk the path with them and willing to coach them along the way. The best mentors may not necessarily be the ones occupying the highest posts, but they are the ones who may be willing to dedicate time, the proclivity and the passion to guide the next generation.

4. Be strategic in using professional networking sites such as LinkedIn. Our generation is blessed with online networking platforms that can help emerging researchers identify and reach out to professionals locally or globally who could serve as mentors and/or collaborators. There are several mid- to advanced-career professionals engaged in relevant health research activities who have also traversed the same path as these young students, and may be interested to serve as mentors to young people whom they have same interests or can identify with. For example, during the panel, Renzo shared that through LinkedIn, he was able to meet Professor Phua Kai Hong of the National University of Singapore, who later provided invaluable inputs for Renzo’s paper on migrant health coverage in Southeast Asia. To top it off, Prof. Phua accepted the invitation to be the keynote speaker for the NL4H Pre-Forum!

5. Never commit the folly of underestimating your peers. In our pursuit for linking with those more experienced than ourselves, we forget the value of social and intellectual capital inherent in our own networks composed of fellow emerging leaders. Leveraging peers to test our ideas, practice our presentations, and critique our papers is an important part of not only enhancing our skills but also nurturing our networks. We encouraged participants to benefit from the strengths and experiences of their friends and colleagues, and to invoke principles of peer learning and feedback. Furthermore, a bit of healthy competition within our networks may drive more creativity and innovation, as long as at the end of the day, we remember that we are united under common goals of improving health and achieving health equity, no matter how diverse our backgrounds and skills may be.

6. Building capacity in institutions is critical. During the panel, we were asked by a technical staff from a government agency if we EV4GH alumni are available to work as consultants to support the creation of posters, presentations, and communication strategies both for the health research and policy community as well as the general public. First, we clarified that it is important to make a distinction between public health communication (whose aim is to modify behaviors, inform about health threats, etc.) and communicating research to decision-makers and fellow researchers – nonetheless, both forms of communication may follow similar principles. However, while the request was flattering, we emphasized the importance of institutional capacity building so that there will be no need for external consultants to perform these routine yet essential tasks. What would be perhaps worth exploring is replicating some of the EV4GH methods of training and coaching for these organizations. In this vein, multiple employees would benefit from enhanced research communication skills, a system of embedded capacity strengthening could be instituted, and a culture of effective knowledge translation could be fostered.

7. Emerging voices should demand for strengthening of national health research systems. In relation to our thoughts about institutional capacity-building, the vitality of local health research also boils down to strong health research systems that ensure long-term professional development, provide incentives for the conduct of effective and relevant research, ensure sustainable funding support and other resources, among others. There was huge enthusiasm among the attendees in the room for research; however, there was also enormous concern about low salaries, ‘contractualization’ of research positions, lack of mentors and role models, limited opportunities for postgraduate training opportunities, and in general the uncertainty of their future research careers. We urged the young leaders to proactively advocate for reforms specifically in the Philippine health research system, so by the time they have graduated, they can be guaranteed fulfilling opportunities in their journey in health research.

8. Be creative in finding resources for health research and innovation. One participant asked a very practical question – how did EV4GH panelists fund their research projects? Nasreen’s study was funded partly through a grant by DfID Future Health Systems Project, partly through awards and partly through work-study; Bev and Renzo’s research used data they collected as part of their paid work, and Bhaskar’s project was funded through his home research institution – in short, there is no single funding source for research. However, while financial resources may be limited, there is a need for new leaders to look at innovative mechanisms and novel sources for research funding, such as by tying research with social enterprise. We also encouraged the attendees to maximize online platforms such as Asia which regularly publishes funding opportunities for research projects. Finally, as demonstrated by Renzo’s research paper, one can conduct, for instance, desk reviews with collaborators from overseas even without meeting them face-to-face, thanks to e-mail and Skype (Note: His paper was published even before he has met in person two of his co-authors!).

9. Building research and innovation programs, not projects. In the panel, Bev and Renzo raised their concerns regarding “projectization” of research particularly in the Philippines, which is also happening in many low- and middle-income countries. Most of the research projects are commissioned to individuals rather than institutions; therefore, there is the tendency to commission more projects, with smaller budgets per projects rather than larger multi-year contracts. There is also often the misconception that qualitative work is cheaper and can ‘replace’ more expensive quantitative nationally representative research studies. Such a lack of holistic approach leads to unusable work (or at least inconclusive, hence cannot be used to arrive at generalizations for policy-making), poor databases (because sample sizes are small, etc.) and lost opportunities for institutional research capacity building. Moreover, it is difficult to encourage promising researchers to build a long-term research career. Therefore, thinking of research in terms of programs instead of projects is beneficial in order to avoid fragmentation, ensure coherence among component research projects, and build long-term sustainability overall. While existing research programs and consortia in health systems are predominantly funded by organizations from high-income countries (such as RESYST, REBUILD, and Future Health Systems), countries which recently allocated significant amounts for health research such as the Philippines (at around 200 million Philippine pesos or 4.3 million USD per year) already have the initial resources to build long-term impact-oriented research programs that may eventually encourage other stakeholders such as the private sector to top these resources up with additional investments.

10. Health systems research and innovation is an exciting field for those who want to make a difference. Today, there is a worldwide recognition that in order to improve health outcomes and achieve health equity, strengthening health systems is the way to go. The emergence of networks such as Health Systems Global is a manifestation of this sea change in global health. What is exciting about health systems research is that it requires multiple disciplines and perspectives – this is the beauty of conferences such as the NL4H Pre-Forum in which students and young researchers and innovators from a wide range of disciplines and professions were gathered in a weekend conference. It was also raised that health systems do have a complex architecture and even fuzzy boundaries, thus opening new arenas for inquiry, and therefore there is always room for emerging researchers and innovators to explore, even experiment, and examine health systems beyond the traditional ‘six building blocks.’

For instance, Renzo expressed that his research interest is investigating the interface between health systems and the broader transitions in health such as climate change, migration, trade, and urbanization, among others. Bhaskar, on the other hand, took a unique perspective on human resources management by looking at the micro level, and emphasized that understanding roles and role-related stress experienced by health workers can be a useful framework to gain better insight into health workforce issues. Nasreen’s unique approach to understanding the flow of knowledge in health systems using SNA illuminated the complexity and multidirectionality of the various elements of a health system.

Conclusion: The ‘Emerged Voices’ should reach out to the ‘emerging’

During the session, it can be noted that the demand for enhanced skills in knowledge translation and research communication was clearly high – from students as well as from institutions. The value of tailored, timely, and context-specific research uptake mechanisms that promote a variety of voices was also clearly demonstrated. It is therefore important to strike while the iron is hot and start creating opportunities to meet this demand.

The EV4GH program also evoked much enthusiasm from the floor, with many participants wondering not on how they can apply for the next edition in Vancouver in 2016, but on how such a program can be replicated in their home countries. Hungry for innovative ways of training and capacity development, the participants challenged the panel to make the global Emerging Voices program one that is more local.

We therefore call upon all fellow EVs to become mentors and trainers, and to reach out to the young voices in their respective communities. Let us capitalize on the momentum by sharing our learnings and skills with peers and fellow colleagues. We can arrange brownbags in our institutions, panels at conferences (or even separate events such as the NL4H Pre-Forum), student groups, professional committees, deliberative dialogues… whatever it may be, let the knowledge gain power, let the skills gain traction. Create an EV legacy by being the mentors that those ahead of us, behind us and beside us all seek when it comes to being a resounding voice for better health for all.

Renzo Guinto, Nasreen Jessani, Bhaskhar Purohit and Beverly Ho

About the Authors/Panelists

Renzo Guinto (EV 2014) is the Campaigner of the Healthy Energy Initiative of Health Care Without Harm-Asia and director and co-founder of #Reimagine Global Health. He is a co-investigator at the Universal Health Care Study Group of the University of the Philippines Manila, and member of a WHO steering committee on social determinants of health and health professional education. He is also the chair of the New Leaders for Health Pre-Forum and of the ‘Health in Megacities’ track of the Global Forum on Research and Innovation for Health.

Nasreen Jessani (EV 2014) is a consultant in global public health policy and systems based in Johannesburg, South Africa. Her work spans health system strengthening through evidence-informed decision-making. She recently received her DrPH from the Johns Hopkins Bloomberg School of Public Health and is on the advisory board of Academy Health’s Translation and Dissemination Institute and a WHO Foodborne Diseases Burden Epidemiology Reference Group (FERG) task force on knowledge translation and policy.

Bhaskar Purohit (EV 2014) is an Assistant Professor at the Indian Institute of Public Health Gandhinagar, which is part of the Public Health Foundation of India. He received his MPH from the Harvard School of Public Health.

Beverly Ho (EV 2012) is a faculty at the Ateneo Loyola School’s Health Sciences Department. She co-founded the Fellowship of the Pump, a mentoring/support group for health professionals and medical students passionate about health systems. She also co-founded Alliance for Improving Health Outcomes, Inc. She recently received her MPH from the Harvard School of Public Health.

The deliberate focus on research to policy, practice and people, which one may consider narrow, focused on an issue that often ends up being one session or one workshop of large global conferences: an add-on so to speak. Just like M&E used to be an afterthought in projects and programmes in the past, knowledge translation, communication, research uptake etc until fairly recently has been suffering the same plight. The ResUpMeetUP symposium placed it front and center.

Organised by AFIDEP, IDS-Sussex, Quaternary Consulting and funded by UK DfID, the symposium attracted researchers, research uptake managers, communications experts, funders and students to Nairobi, Kenya from 9-12 Feb, 2015. The participants’ affiliations varied across sectors (water, agriculture, health), disciplines (communication, research, evaluation), organisations (funders, NGOs, think tanks, universities) and geographies (mainly Europe, Africa and Asia). While this is by no means an exhaustive list or representative sample, one really is compelled to ask – as always – psst….who’s missing?

So what does one talk about for 2 days on research uptake?

Well, first of all what is research uptake? What does it mean? Who is it for? Who does it? Is it really different though from other similar movements (K* etc) or does it reflect Shakespeare’s famous line from Romeo and Juliet – “A rose by any other name would smell as sweet” and thereby reframing (renaming?) a symposium on #knowledgetranslation/K* as one on #researchuptake? However, pseudonyms aside, issues such as ethics of research uptake, the role of funders in encouraging research uptake, the challenges of measuring impact of research uptake endeavors, and the dilemmas of researchers in playing advocacy roles struck me as some of the important contributions (amongst many) of such a symposium.

The struggle with not always knowing the best methods, strategies and tools for research uptake used to manifest as a thorn in the side of researchers and decision makers alike. The symposium demonstrated however that importance of research uptake has gained more attention over the last few years. As one can imagine, for some this was a new and exciting gathering of like-minded actors; for others this sounded just like new packaging of an old idea. Innovations in strategies for research uptake were inspiring for many but unsurprisingly  led to questions about capacity building in research uptake.

What remains to be seen however is whether ResUPMeetUP will be able to replicate its power to convene with power to retain: will the dispersion of participants be accompanied by dissipation of energy? Self-selection into most conferences and symposia by default is a gathering of individuals and organizations with a similar penchant.  It also favors those able to communicate in English and by circumstance therefore limited in sphere of influence and scope of contribution. Was ResUPmeetUP, once again, an example of a mass gathering that sought to preach to (and learn from) the converted? Will the values, beliefs, skills and energy go beyond those who already have a proclivity to promote research use? What next? More reflections coming soon…