Working in different spaces in recent years, but also wanting to strengthen the health system overall, I have observed just exactly how fragmented our work is and the types of silos which (still) exist. If you don’t like the cold hard truth, perhaps you should stop reading now : )

So, we have our health systems cliques, our gender equality circles, the HIV world, the non-communicable disease advocates (hee ha, yeah we’re beating #NCDs) and well, the list is endless. Now, I have definitely learnt a lot being around in these different areas of our health systems but the question I keep hitting my head against the wall on, is how on earth does all of this come together? Our health systems are so diverse, from the pharmacist to the human geneticist (yep it was great addressing all of you recently), how do we bring it together and more importantly, when will we begin to do so?

Yes, I hear some of you saying (/chanting), “UHC, UHC!” and the even more holistic types among you, “SDGs, SDGs”!” but sorry, that won’t cut it. Just check your Twitter feed.

What sparked this short reflection? Well, Moeketsi Modisenyane (South African Department of Health), who once at a conference said that as a policy-maker it was difficult to gauge what to do from research presentations and recommendations; most of us create politically correct, soft, probably never to be implemented recommendations (yes, I am guilty too).

Now just imagine if you were a policy maker this month on social media, specifically on the 11^th of October. I am not joking, we had in just one day, THREE critical issues, I repeat: ALL IN ONE DAY. Tweeting separately or running digital campaigns with absolutely no overlap or thoughts on cross-cutting issues (well, I bet so) and well pushing our individual priorities was the most important, right? A day before (10^th October), we raised issues around World Mental Health Day, followed by 11^th October and, in no particular order;

• Day of the Girl Child
• World Sight Day
• World Obesity Day

Now I don’t know about you, but I thought OMG! I am passionate about all of these issues (one of them is my bread and butter too, important to disclose #justsaying), I have so much to say on each issue, but being a tad tech savvy I also know that if I post on each issue, I will be confusing my followers but hey, more importantly than my following, have we all thought about how confused this can make decision-makers?

Then of course, being an activist comes with individual action first, so I attempted to push some critical thinking and began tying up these issues: survivors of gender-based violence (GBV) require mental health services in our systems, those who are forced into child marriages rarely have the psychosocial support either. Obesity is inherently interlinked to stigma and particularly tougher on one gender (guess which one), which is also linked to this year’s World Obesity Day theme, “weight stigma”, but hey, that’s in turn also tied into mental health. Let’s turn to the “blind girl”, the experiences and double oppression there (#intersectionality).

This is just a first and by no means perfect attempt, at least in my brain, to start thinking beyond fragmentation and silos to cross-cutting issues, the importance of alignment of our programmes, our thinking and our messages, particularly to work through this “Global Health Confusion” which has been created and which we are (still) creating, in spite of the (presumably more holistic) SDG health era. So let’s not stop this thinking, add on your thoughts! And don’t ride the waves, we just surfed HSG #HSR2018,  #WorldFoodDay, Pink Month for Breast Cancer, (World Health Summit) #WHS2018 and now we’re surfing full speed towards #AlmaAta40 #Health4All and please do not forget the Ebola crisis in the Democratic Republic of Congo !

All of this is equally important, but let’s face it, you may get a tad confused with all the worthy issues mentioned in this blog alone; we need our “systems thinking” hats on, with room for critique but also reflection: where exactly are we going with all of this and with what impact other than (creating even more) confusion and complexity for decision makers?

Perhaps, someone like Dr Tedros would be best placed to bring all of this together, given our demands and his role in confronting all of it, eh? From what I heard, he (and his fellow leaders from global organisations) are trying to do so, with a Global Action Plan for healthy lives and well-being for all, that aims to go “beyond the silos”.  We should all get on board!

Anyway, one aspect of the EV training which stands out compared to other training is the cyclical system of leadership and having, at hand, a pool of experts ever-so-willing to give back. EV alumni have been playing this coaching/facilitating role in past EV ventures and are doing so again this time around. Francisco Oviedo-Gomez (EV 2012) and I had the privilege of recently facilitating a thematic discussion “Global inequities in Health System Research” with the sixth cohort of change-makers (#006) and one of four thematic discussions this year.

The thematic discussions had us provide only the context and critical questions (below) for it to spark off the debate from publications, language barriers over weak health systems to modern-day exploitation (oops we mean unpaid internships) and most importantly, action-oriented thinking!

• What are HPSR inequities in your own context, either in the workforce, HPSR or publications/grants?
• What are the drivers of these inequities?
• Now that you’re an EV, how will you change these dynamics once and for all?

Below you find just a flavor of the discussions. We surely hope you will get to meet the new cohort in Liverpool for a more in-depth conversation  (provided you get a visa (and funding) yourself, ahum)!

 “Not being able to afford publication fees is an everyday thing for a researcher in Argentina. Before being an HIC, we were able to ask for a waiver, but now I do not know how we will manage” – As you might have guessed, a quote from a Latin American EV, on what happened when Argentina became a “high-income country” (while many of its citizens and researchers felt anything but).  Things haven’t really improved, as you know; this week the Ministry of Health in Argentina got abolished.

 “As a former intern at WHO and then later as an employee of WHO, I observed first-hand the low representation of interns from low-income countries (LIC’s). This is mainly because interns at WHO are unpaid and the high living expenses in Geneva make it extremely challenging for possible interns from LICs to consider WHO as a possible workplace”- quote from a new EV from the Middle East. The hope is rising, as you know, that this dire situation for WHO interns from LMICs will improve under Tedros.

From one of the countries which sparked attention to weak health systems in our time and well, which basically encapsulated inequities:  

“Recently the country had its recent turbulence in its health system with the Ebola epidemic in which a declaration of an emergency state was proclaimed.”  “… Main drivers of inequities in my country are poor remuneration of the health workforce, inequality in remuneration of various cadres of the health workforce, lack of highly skilled health care workers from the various cadres because of workforce movement for better opportunities overseas, and lack of funding for research’.  Elaborating a bit on the latter, “Research funding by the government or its institutions is not readily available because it’s not prioritized except from donor partners who usually have a specific focus.” (EV from a fragile & conflict-affected state in West-Africa)

Another interesting one, and I wonder which “health workers” this EV from Sub-Saharan Africa is highlighting here. I agree there are times we have to play the political correctness as EVs too:

“In my opinion, the imbalances in health care in Uganda, stem from the fact that the health care system is characterized by human resource shortages, skill mix imbalance, absenteeism, dual practice, inadequate investment and over-supply of certain categories of health workers.” 

Most EVs certainly sound gung-ho and even visionary, in some cases. From South-East Asia, we were told: “As an emerging voice, I would try to convince involved stakeholders to see that demographic and epidemiological transitions in Cambodia are posing other types of burden (chronic conditions) to the population health, health system, and socio-economic development”.

Another EV: “As an educator, a health system researcher, and now an emerging voice, I believe that the only way around having more research conducted by LIC authors that gets at the heart of strengthening health systems in low-income countries (LIC) is by starting from the bottom-up.”  He even used the term ‘creative destruction’ – “destroying something so that it can be built up again from scratch”.

So, as you can tell, the new EVs are more than keen to do something about the huge inequities in health, research and other aspects in their own settings and at a global level, and the responsibility (and even moral duty) to go beyond academic outputs to trigger change. Some of them even seem ready to take on top-level decision makers, immediately after Liverpool! One day, a Hollywood, Bollywood or Nollywood director will make a movie about these rising health agents of change  (although I’d personally settle for a Netflix series on the EVs).

The whole discussion made me feel a bit nostalgic remembering my teens (okay, felt like it anyway) when we had those EV emails pushing you onto our online Moodle platform and creating your posters well ahead of Health Systems Global – and trust me this comes in handy. And so do these crucial discussions which no doubt shaped me to be a “constructive troublemaker” as I often put it!

*Views are that of the author and not representative of any organization.

#SAT4YOUTH has three core components, namely, supporting youth to meaningfully engage (and for real, not the two-minute Malala Yousafzai address at the 2015 Sustainable Development Goals Summit in New York), post conference participation e.g. report-writing, vlogging but also a leadership programme aimed at creating #YouthQuake in SRHR.

Now for those of you, who for whatever reason on earth (probably a really uncool one), don’t know what “YouthQuake” means, it was officially named the 2017 word of the year by Oxford Dictionaries. So to keep up with the times let me spell it out for you: YouthQuake = significant cultural, political, or social change arising from the actions or influence of young people. Now I don’t know about you, but I reckon that’s exactly what’s needed to uproot gender inequality and health systems research (the Emerging Voices way, sorry, uhm, bias in check) but also to create the Africa we so desperately need and want!

On that note, we coupled blogging expertise (the real Shakira), youth from across Africa and the ever-so –hip-young diplomat and significant contributor to the African Union (AU) Youth Division – Kokou Sename. During the interview, youth were starry-eyed as they learnt the art of blogging but also engaged with a top level diplomat around youth power, leadership (Kokou is probably the next head of the AU, or so we hope) and what we should consider before starting #YouthQuakes!

Young Leader – AU Engagement Groundies Left to Right; Kokou Sename, Akende Simamuna, Raymond Mazhambe, Hastings Banda, Linly Dumuka, Shakira Choonara, Patricia Hamura, Beverly Chogo, Millicent Sethaile, Tambudzai Magwenzi and Bosa Sabele

In case you didn’t know, a “groundie” is a portrait photograph taken when you lie on the ground.

Below are the types of questions youth were interested in and Kokou’s revolutionary responses.

1. Sorry we just have to ask, how old are you and tell us about your present role in the AU?

I am thirty years old, I started as a young leader and moved across different sectors all the way to the national level and now I’m in the AU serving 44 countries in Africa; for me it’s definitely a way of having more impact and responding to the needs of young people. At the core of my work is strengthening the AU Youth Division, where we need to ensure an AU common agenda on youth, building capacity and partnering on interventions to include issues of gender and the demographic dividend. The AU actually declared 2017 “the year of harnessing the Demographic Dividend” but I don’t hear many speaking about this, so that’s what my core work entails i.e. taking these high level commitments and making them accessible, capacitating youth and ensuring it becomes a reality.

2. What are your thoughts on the African Youth Charter?

The AU Youth Charter was actually adopted in 2006, but only in January this year it was decided to ratify the charter. Young voices and their contribution are very important. We will assess the AU Youth charter which will feed into a decade plan of action 2009 -2018 – assessment this year. It’s a nice intervention, a continuum of advocacy and a strong mechanism where you can hold people accountable. If I promise to bring you tea and I don’t, you will ask me, but if I don’t promise you, you can’t really hold me accountable. Someone has to put pressure to push to implementation and monitor.

3. Why is everyone so old in the AU? Why are there so many grey hairs?

A reform of the AU was called for, and led by President Kagame,  the current AU chair.  Part of the reform is to improve the number of youth representatives. The AU will soon comprise a 35 percent youth workforce, and we surely need these youth. We all face that job dilemma where you’re qualified but not considered to have sufficient experience; part of our programme is to allow for youth to be deployed to different countries (yes, they do receive a stipend!) and gain work experience. I also began my career in the programme, so yes, it is getting better.

4. How are you going to be part of the YouthQuake?

Thinking of the word, I tried to compare it with an earthquake and considered what happens when there is an earthquake. Part of that answer lies in those who will shake things up. Either you “have” a disaster or you will harness it, it needs to be way innovative, you need the thinking – and outcomes. Sometimes we miss out what will happen with innovative/ critical questions. Don’t accept, borrow or steal; improve and find better ways!

So I’m not sure about you, but clearly, this is the beginning of massive change the continent will see, groundies have paved the way for new methods of engagement which I also hope to see at the Health Systems Global conference in Liverpool this year (although, if I’m given another poster presentation, will probably boycott in the name of meaningful youth engagement)!

All opinions expressed in the blog are that of the author and not the SRHR Africa Trust

One of my favourite theorists, Patricia Hill Collins, has written extensively around the matrix of domination/oppression which exists in society. In the case that I will discuss however, the focus will be on the role of youth and gender in the achievement of Sustainable Development Goals (SDGs), particularly in the area of sexual and reproductive health rights (SRHR).

We recently brought academia and activism together around a virtual roundtable, where we were able to have a  discussion with young feminists aged 12-25 years.  We published a “first of its kind” paper on the meaningful engagement domain, titled Sustainable Development girls: mapping youth advocacy and action to achieve sexual and reproductive health rights in Africa.

Some key findings, which are in line with this year’s theme #PressforProgress of International Women’s Day, provide food for thought, and a good way to spend the day would be to ponder over the powerful and raw words of young feminists in sub-Saharan Africa.

Theme 1: Understandings of gender – light at the end of the tunnel as we move beyond the binary

“Gender should not be limited to being a woman or man instead it is about being a human being,” – Participant 1

Theme 2 – Introspection on critical incidents leading to much needed activism

“There was an instance where I tried to get support from service providers but could not access the health facilities. The major challenge has been the discrimination around being sexually active…as a HIV positive teenager I often would not receive the required treatment.” – Participant 1

“I had an encounter with a nurse when I wanted to do a pap smear. I was just 20 years old at the time and I was at university. I was so discouraged by the poor attitude of the nurse who insulted me by saying that, ‘I don’t need a pap smear or is this because you are sexually active at this young age?’ I actually never received the service nor did I ever return to the facility.” – Participant 2

“When we look at the realities and stigma of menstruation; girls use socks filled with cow dung, I wrote a blog on the issue which an organisation noticed and led to my interest in this area of SRHR.” – Participant 3

Theme 3- the most vocal, was exploring how the matrix of oppression works in society (being a young female) and the likelihood of achieving gender equality, SRHR and the broader development agenda

“The SDGs are nothing but commitments and policies, they won’t be achieved because youth are forgotten and not involved in processes.” – Participant 1

“I think it is unlikely that we will achieve the SDGs, the drawback is that there is still too much patriarchy and men are essentially more powerful than women.” – Participant 2

“SDG-wise, we are trying, but the future is not bright and that is why I am an activist to change the future.” – Participant 3

Now I’m not as young as the 16-27 year old activists with this bleak view and experiences, but even with a PhD and a long list of accolades and renown for public speaking (hey, maybe some would reckon even beating Paul Farmer, ahum), I was recently invited to a so-called panel with the UN Youth Envoy where more senior participants were given the platform on stage, while the youth were told to stand in a line. Being an Emerging Voice and also obviously a revolutionary, I challenged the status quo and stated “I was invited to a panel with the UN Youth Envoy so I am going to pick up my chair and be part of this panel” [see Youtube ].

I gate-crashed the panel, as you can see, but the truth is that even with all the hype and buzz around meaningful engagement, there are still many significant and noticeable gaps, more so for the many women in our spaces. So, perhaps, there is not too much to celebrate as yet.

Picture Africa Conference on Sexual Health and Rights (2018): United Nations Youth Envoy (Jayathma Wickramanayake), Shakira Choonara and Executive Director of the United Nations Population Fund (Dr Natalia Kanem)

Reference: Choonara, S. Banda, R. Chitimira, R.Ditsele, G.

Hwengwere, M. Magwenzi, T. Phiri,C. Simelane, Z. Masikati, I. 2018. Sustainable Development girls: mapping youth advocacy and action to achieve sexual and reproductive health rights in Africa. Agenda. https://doi.org/10.1080/10130950.2018.1427812

There has long since been the issue of knowledge translation, impact and particularly influencing policy, but let’s face it there are few instances (e.g. researchers lobbying for the sugar tax in South Africa- SA) where this is the case, other than that all evidence tends to remain locked in ivory towers where perhaps a magic wand will one day release and influence policy. I reckon the magic lies in the art of truly engaging policy makers – not those once-off end of project meetings hosted in fancy hotels.

In the new age, there are two main mechanisms to influence politics (main stream media and social media – look at #Covefe discussions for instance). In South Africa, media play a critical role in this. You have to ask yourself the question : do I have enough connections with mainstream media? If not it’s unlikely your work will ever reach political agendas and priority setting. During my short (but dare I say celebrity struck) career, I have learnt the importance of every media connection : I started out speaking about healthcare issues on small community radio stations to being featured on national stations which for example led to engagements with youth, the broader public and even policy-makers on the national health insurance (NHI) in South Africa.

We tend to view policy-makers as being out of reach. My experience as a health policy and systems researcher (in my previous life anyways) was that we would spend close to two years planning a meeting, tread carefully on being objective, go through a million levels of bureaucracy – but rarely actually ever engage policy-makers.  Working just close to six months in the civil society sector, I have watched in awe as our country offices (Southern African AIDS Trust) take just a week or two to bring together meetings which include youth, the community, religious or traditional leaders (yes they are super important too) and high-level representatives from the Ministry of Health, Gender and even the Ministry of Police who actually became key stakeholders in our projects. In fact, on my last visit to Malawi, I simply adopted this proactive approach and asked a member of parliament if he would give me a tour of the parliamentary precinct – to which Honourable Justin Majawa gladly agreed and picked me up at 07:00am the next morning for what I would deem the best tour of my life. The Honourable explained parliamentary processes, ushered me into areas strictly reserved for MPs and showed me documents such as the minutes, agenda’s,  and reports sent to MPS, which I’m now excited to have as important artefacts. Establishing a working relationship was another (rather pleasing) outcome of this encounter.

The same goes for the Director General (Dr Tedros) of the World Health Organization (WHO), my favourite person at the moment when it comes to youth engagement. I have been engaging him on social media and he is extremely responsive and open to youth initiatives and promoting youth-led work. In fact so much so that the engagements have led to fellow EV Renzo Guinto and I co-leading a joint-write-up with the DG – watch this space! Not forgetting that he also retweeted our upcoming session at #ECTMIH2017! If you’re a “senior” in HPSR at the moment, other than Professor Wim Van Damme , you can’t be cooler than Dr Tedros (perhaps a need for pointers from our DG on this).

So what would be my key lessons ? Make those links with media personalities (the influence is unreal), be proactive because policy-makers are not as far removed from our world as we believe they are and finally catch all our action next week at ECTMIH, where I look forward to beating other EVs hands down during our debate (Faraz Khalid, Kerry Scott, Sameera Hussain, Seye Ambimbola, Prashanth N.S , Raoul Bermejo) for I am an ex-comrade after all!

I was invited to facilitate a community dialogue in a poorly developed community in South Africa – for those who have been here before it’s about a 20-minute drive from Johannesburg, so not too far from the economic hub.  Being oh so “young” this was my first experience actually engaging community members on their healthcare experiences. Now in preparation, if you google “community dialogues for health”, a ton of handbooks come up, including one I particularly enjoyed by the Malaria Consortium, titled, “Learning paper: Community dialogues for healthy children encouraging communities to talk”. But I am not so sure that the panelists took the time to google, let alone get the drift of what community engagement rhetoric actually means.

Panelists ranged from senior managers in SA’s Department of Health, advocacy officers among leading civil society groups to community activists and clinic staff who serve the community. The majority of panelists literally showed up with PowerPoint presentations, with complicated graphs, speaking a jargon only they understood, and I quote, “PHC access is increasing according to this graph, can anyone tell me why”? The room was completely silent (in “shock and awe” presumably ) and continued to be that way, as key stakeholders from the Department of Health rattled off, “UHC, NHI (National Health Insurance), CHWs, environmental practitioners, clinic committees (supposed – community governance structures at health facilities), …”.

Not sure if they thought they were at an academic conference (no offense) but individuals either below fifteen years of age or well above the age of 80 were definitely not engaged. Except of course when the community activist stood up, spoke from the heart and captured their attention (much to learn from activists!).  Just from observing the likes of possibly the greatest facilitator of all time, Simon Maxwell, I learnt the art of facilitation is to truly engage the audience.  With little choice other than hoping for a power outage to stop the PowerPoint torture, being the (assigned) facilitator I had to salvage the situation and bring panelists (no matter how high, dry  or mighty they were) back to the point and purpose of a community dialogue. A dialogue that was so important on many fronts, especially on understanding patient experiences which we need to read, listen to, remember and reflect on constantly. A few quotes are telling enough:

• Community member 1: “I am not sure about the paper based systems, every time I go to the clinic/ hospital I have to wait hours and open a new file, every single time.”
• Community member 2: “I can’t go to the clinic which is so near to my home because they often don’t allow my son to park in the disabled parking, you can see I am disabled, the security can too but he won’t allow it. So we often have to drive to another hospital, which makes provision for disabled parking”.
• Community member 3: “There is no confidentiality at the clinic, they shout at you, “here are your antiretrovirals (ARVs)”, so everyone knows you have HIV, there is no respect”.
• Community member 4: “I used to have to spend a whole day to go to the hospital for my medications, I would go monthly, but I have no one and now I am too sick to go so I am not even taking my medication at the moment”.

Community member 4 somehow touched my heart, a beautiful but old and frail women, literally all alone facing a multitude of access barriers. For me, she was finally putting a face to what we mean when we talk about vulnerable populations, particularly the elderly. Somehow I decided to reach out to her, (yes in the middle of the facilitation), while one of the panelists was rambling on about some policy or the other. She requested that I help her up and pack her some sandwiches. But the human side of me knew I had to do more somehow, I gave her my business card and tears rolled down her face, and I fought back tears too. It’s an experience etched in my memory of how the majority of our health systems face the challenge of caring for an ever-growing elderly population.

I certainly learnt some profound lessons from this experience. When we discuss people-centred care, reach out, try to understand communities, understand each patient, listen to the patients’ voices, patients’ experiences, demands, … we need to ask the question of how to change such realities for the better.  Both at “community dialogues” and, even more importantly, in the everyday reality of our health systems.

*Opinions expressed are not necessarily that of the Southern African AIDS Trust but of the author

If everyone could stand up, raise your right hands and say #HEAIDS! One more time, #HEAIDS! Fantastic you can take a seat and do follow me on twitter @ChoonaraShakira, I hope to be trending on twitter after this discussion (… I’m just joking!). On a serious note, I know many of you may be hungry, ready for lunch, but a few key issues I would like to raise today, please bear with me, I guarantee you it will be life-changing!

Firstly, the opening panelist, Professor’s Bawa’s (Chairperson of the Higher Education South Africa) address was so fitting for the current state of affairs regarding HIV/AIDS and leadership. What I extracted as a central point from the recently launched National Strategic Plan for HIV, Tuberculosis (TB) and sexually transmitted infections (STIs) – South Africa (SA)! I ask you, when we look at present leadership in SA, do we see HIV/AIDS making headlines? No! We see corruption, we see poor leadership, but we no longer see HIV/AIDS! Tomorrow, I hope we will raise this with SA’s Deputy President who will be attending the conference. We have seen a generation of leaders pass on, Nelson Mandela the 46664 concerts to raise awareness, where do we see political leadership of that stature now, other than perhaps the Desmond Tutu Foundation! We need more of this in our political sphere, not corruption and not poor leadership!

By a show of hands, how many in the audience have visited campus health facilities at the university or colleges? [Majority of the audience raises their hands].

Wow! When you take a look at me, you may think that I have visited these facilities, especially being in the medical profession, but to be honest I have not. Allow me to draw on personal experience. Being from a very poor background, when I got to Wits University (University of the Witwatersrand), society has this stigma. If you’re standing at a National Student Financial Aid line (loans for disadvantaged students), people know that person is poor, that student cannot afford fees. That was one of my first embarrassments, it took me many years to realise that this is not an embarrassment. The second embarrassment I had, is when you look at these hands [shows hands to audience], they look perfect and that’s the thing about disability, some disabilities are invisible.

Two years ago, I was diagnosed with what is known as arthralgia, more commonly known as arthritis. The stigma I experienced at a university was immense. There were times that staff and students would tell me things, I would literally go back to my office and cry.

It’s these sort of experiences which had me thinking, would I ever, if I needed HIV information, go to the campus health facility where nurses are rude, unhelpful? Would I go to be further stigmatised? And the answer is, I never went. Now, though, I have reached a different stage in my life where I no longer care about stigma. I have learnt that you’re not disabled but differently-abled.

I never expected to be differently-abled myself, but I have always been advocating for the right of persons with disabilities. It is so easy for us to say this in our speeches, to commit in our policies; ‘Let us include gays and lesbians, let us include persons with disabilities.’ I said this two years ago at the European Union, but do we actually implement anything for persons with disabilities? When we speak about contraception, condoms, just as I mentioned the access barriers at a university, let us not even go into the access barriers for person with disabilities. Do you see wheelchair bathrooms having condoms? But, you see this in the normal bathroom?

For the second example, I am going to request someone from the audience who would like to volunteer for what I’d call a PowerPoint but not really a PowerPoint, because I was just telling a colleague earlier we have or experience ‘Death by PowerPoint’ and instead as young people we need to stand up, we need to be innovative, we need to show impact and be different, not follow the norms!

Can I have a volunteer from the audience who is going to have something to do with this scarf [holds scarf up and blindfolds Gugulethu i.e. a volunteer from the audience]?

Young people, we have been asked to provide solutions to the HIV/AIDS epidemic. I am here today, to show you what we mean by solutions, accessibility and truly leaving no one behind and specifically for those who are visually impaired.

Demonstrating vulnerability, inaccessibility & solutions for differently-abled condom usage

Shakira: Gugulethu, I have two condoms, I am placing one in your right hand and one in your left hand. Can you tell the audience which is a male and which is a female condom?

Guglethu: The right hand is a female condom and the left is a male condom.

Shakira: Excellent! What a stroke of luck, the condom packaging has pictures and instructions for usage, can you see the instructions?

Gugulethu: [Silence], no.

Shakira: There is a hotline number enlisted on the condom, can you see this?

Gugulethu: [Silence], no.

Shakira: Finally, can you open one of the condoms for us?

Gugulethu: Struggles and tears the condom in the process.

Shakira: Thank you Gugulethu, a round of applause for her!

Link to excerpt of speech: https://www.youtube.com/watch?v=hHgb0KcYRo8

That, ladies and gentleman is precisely what is meant by our interventions not being tailored to vulnerable populations. The period of risk even when attempting to use contraception for prevention, the possibility of a condom tearing. While, eventually usage of the contraceptive will be figured out by a differently-abled individual, there is a period of vulnerability where one is susceptible and at risk of possibly contracting HIV. As a young person, the one solution I bring to the table at this conference is to ensure accessibility of these condoms and I challenge industry to innovate in this regard.

I thank you!

Post-independence, several countries celebrated African Liberation Day, now more commonly known as Africa Day, to celebrate the continent, independence and also the formation of the Organization of African Unity (OAU), now labeled the “African Union” (AU). Unfortunately, there is little to celebrate given that the continent’s development hangs on two extreme threads. We have just over 10 years left to implement the ‘mission impossible?’ Sustainable Development Goals (SDGs) (and our own version of Tom Cruise has not yet ‘emerged’, as far as I can tell). On the other hand, Africa’s landmark and tortoise flagship development plan, Agenda 2063, makes it look as if the AU actually plays a meaningful role in Africa, and their reports certainly won’t tell you otherwise. The lofty Agenda makes provision for another forty-six years of talk shops and promises by some elected (and let’s not forget the many “self-elected” life-long) African leaders, and a deadline which the greatest resource that Africa has (i.e. its youth), may never even have the opportunity to see, given our present and overbearing dilemmas. Guess you figured out by now that I’m not exactly in a celebratory mood today. Damn right.

From the re-emergence of Ebola on the continent (which gets plenty of attention these days in Geneva and elsewhere) to listening to young girls between just ten and sixteen years old two weeks ago (yes, just ten to sixteen years old – I do have good things to say too, so congrats to  conference organizers for true youth inclusion, totally loved this! ), is arguably quite a leap.

Nonetheless, at the recent ‘End Child Marriage’ conference in Maputo, I was struck by just how much our health systems and laws, citizens and families/ societies have essentially failed young girls in this age group in Africa over the past decades.

Some quotes:

“Two weeks ago I went to hospital, I had nowhere to sleep, I had to put the clothes I had over the sand outside (make a bed) and sleep. Please renovate the hospitals, I am not asking only for myself but for my people”.

A Victim of forced marriage now has a six-month old child – “I am thirteen years old, I did not know that if I had sex, I would get pregnant”.

“I was a victim of a forced marriage, I wanted to go to school but could not afford to go to school. I had then been offered the opportunity to be sponsored to go to school. I did not tell my husband about it, but he heard about it from the neighbours, he went out and returned with something to beat me with”.

So it is great (as well as long overdue) that adolescent health is finally getting more “High Level” attention:  WHO Afro just launched an adolescent health flagship programme. As much as I could go on for hours and even years about Africa’s issues, who knows maybe even until 2063 (when I’ll be a cranky granny, presumably), this Africa Day (#AfricaDay2017), I am all about igniting a discussion around ways to address Africa’s woes and turn the brave new Trump era into the greatest opportunity for Africa, so that the continent can in turn contribute to a shifting and exciting new world order.

Other than tackling corrupt leadership of the worst kind which still reigns much of the continent, in order to meet our health needs and just about every other development need, there are two frank discussions we must push for and forge forward with.

Almost fifty years ago, Ghana’s first President, Kwame Nkrumah, and Tanzania’s first President, Julius Nyerere , who were also founding fathers of the AU, spearheaded the dream of achieving a “United States of Africa”. Nkrumah’s words still hold immense power in taking Africa forward:

“Divided we are weak; united, Africa could become one of the greatest forces for good in the world… [we] will emerge not as just another world bloc to flaunt its wealth and strength, but as a Great Power whose greatness is indestructible”

Other than the AU, and much debate (and controversy) around the somewhat aspirational idea of creating a Gold Dinar as a single currency for Africa, visions for the United States of Africa have fallen off the radar and pretty much fallen flat. Yet, I feel we must ask the question this Africa Day: how can we reinvigorate the vision of Nkrumah and Nyerere once again, so that the continent can make real progress on the SDGs & Agenda 2063 in the decade(s) ahead?

This begs the second and underlying issue of all our woes, or as Karl Marx eloquently puts it, the ‘economy which is the base of our society’. Clearly, economics played a role in Pan Africanism thus far, and that will likely remain the case. It was estimated that in 2012, developing countries received a total of $1.3tn of aid, investment and income from abroad, but in the same year $3.3tn flowed out of developing countries.  The exact figures are disputed in some corners, but the trend is not. ‘Poor’ countries are (still) developing ‘rich’ ones, so perhaps Trump pulling aid may not be all that bad for the continent, but let’s just make sure it’s accompanied by reduced debt, questioning exploitation and while we’re at it, why not also start the discussion of reparations for colonialism?  I wonder if there are any takers, new ‘young’ presidents/ prime ministers in the West perhaps?

The other (major) issue in Africa is not only limited to past colonialism and the Western world. I, for one, find it rather odd – I’m guessing the language here because I can’t read the symbols – but it seems Mandarin signage is becoming a dominant trend in airports, hotels and even on air-conditioner remotes in Africa. Now, perhaps World Peace and catering for the minority populations in Africa are some of the aims, and that would be totally fine with me, of course. However, while not yet a cranky nanny, I’m getting a bit too old for fairytale stories. Frankly, we should ask, are such neo-colonial impositions even legal in our modern-day society?

Now, I am not rooting for populist economic transformation here, but raising questions in the hope that as the African youth (and thus the future of this continent), we will be inspired by Kwame Nkrumah’s vision  and kick-start the much needed change, at least economically, so that no child should ever sleep outside a health facility again! On a higher note, perhaps some of the following suggestions will get us started:

1. Youth must begin to engage with existing policies and hold leaders accountable: I was so impressed by a young colleague in Malawi who during a recent country discussion pulled out a policy document, quoted the content of the document and essentially gave stakeholders a run for their money.
2. (More) female leadership is clearly much needed to achieve a shift in developing Africa. A favourite during Africa Month was perhaps the “Goodwill Ambassador for the Campaign to end Child Marriage in Africa”, Nyaradzayi Gumbonsvanda. A recent quote from her: “We can’t end child marriage through donor-funding… We have our resources, we do. If we don’t buy guns, we can buy books for our daughters…I am tired of Africa begging when Africa is rich”. I couldn’t help but wonder where Zimbabwe would be if President Mugabe relinquished leadership to a leader of this stature.
3. This piece comes clearly too late to still influence the selection of the new Director-General of the World Health Organization (WHO) at the 70^th World Health Assembly. But Dr Tedros, the WHO DG-elect, would do well to keep in mind the (looming) recolonisation by the Chinese, the need for reparations from the old colonial powers, and the ‘achievable dream’ of a more united Africa, during his first 100 days in office and beyond. UHC, one of his core priorities for Africa and elsewhere, will certainly benefit from a frank discussion along these lines.

Last but not least, some recommended tracks to get us started on this journey, from my namesake, “Waka Waka (This Time for Africa)” and “Kenya Kenya” ! Cranky grannies and grumpy grandpas in health systems, feel free to join!

If there is one ‘must-read’ for every health systems researcher, the broader public (national and global) and politician ( be it Zuma, Mahlangu or any of those politicians who failed to even observe a minute of silence last week), it is the damning report released by my new personal hero, the health ombudsman – “The circumstances surrounding the deaths of mentally-ill patients; No Guns 94+ Silent deaths and still counting”. Actually, to be accurate, ex-MEC Mahlangu continued in her post (with no doubt a fat salary check and gravy train benefits) and waited up until the 45^th hour to resign, just in time for the ombudsman report to be released – many interpreted this as her way of avoiding being accountable. Opposition parties in the country are calling for criminal charges to be laid against her and rightly so, though it is yet to be seen if they will indeed materialize or whether she will just be like every other leader in the country who gets away with murder (and seriously no pun intended). On Twitter the saga is referred to under the hashtag #LifeEsidimeni. In addition, the media and other researchers have documented in much detail how the Gauteng department of health in SA transferred in just nine months (March-December 2016) – what was initially thought to be 36 but now already – 94+ mental health patients to Non-Governmental Organisations (NGOs) who operated under invalid licenses and who treated patients like animals, beat them and starved them. Yes, you read that right: ‘beating patients and starvation’. The crisis is no less than a “massacre of vulnerable populations”, borrowing a leaf from an opposition Member of Parliament (MP),  last week in parliament.

When I sat down to read this report the inhumaneness left me chilled, in tears because I questioned how we in public health have allowed this disaster to happen. Moreover, the situation hit home – it got me thinking of a family member I once had in a state psychiatric facility and as I quote the report (see below) I can’t help but think of the millions of equally vulnerable people worldwide and in SA who are still reliant on clearly suboptimal healthcare facilities.

“Two hours before Freddie Collitz (61) passed away in the care of the Mosego Home in Krugersdorp, an old age home for psychiatric patients; he apparently had a wound to the head, blisters around the ankles and a sore on his nose”.

“One day Riaan (30) the youngest son, insisted to take his father inside. There were no sheets, pillows or blankets on their beds”.

“Some NGOs were ‘like concentration camps’, overcrowded with in-kept and hungry patients, several relatives reported severe weight loss captured on photos (Reverend Maboe about Bophelong Suurman and Ms. Colitz on Mosego)”.

Experts including Laura Lopez Gonzales, Janine Bezuidenhoudt and Emerging Voice (EV) 2016 – Andre J van Rensburg also weighed in on the conditions during a recent Public Health Association of South Africa (Gauteng branch) twitter chat:

Yes, there has been significant and notable advocacy and an outcry by organisations such as Section 27, or other researchers in the public health community and even the media, yet politicians as per the report still went ahead with transferring patients and contributing to their eventual, unimaginable, unethical and unacceptable death. In a country with one of the most progressive constitutions in the world (and still boasting the second largest economy on the African continent, let’s not forget), we have let down our most marginalized through our failing health system. A horrifying human rights breach, with criminal consequences.

The sad episode points to three areas we need to consider urgently. The first is related to our research which is meant to protect patients.  This raises the long-standing question of our role as researchers in addressing political disarray and poor leadership (aka, “Trumps of the world and SA”) which clearly impact our health system in one way or another. Is it time we rally behind civil society groupings such as Save South Africa or even run for office ourselves instead of allowing poor leadership to reign and blatantly carry out massacres?  Young researchers in the US can probably relate to our predicament.

Second, cost-cutting was the key reason cited by the health department for this massacre. This shows the continuing fight of not just mental health patients but the high costs of caring for disabled populations in general; sadly, instead of curbing corruption in the health system or other wasteful expenses, “cost-cutting” here compromised the human rights and care of the 94+ and counting.

Thirdly, and I bet my PhD on this, once this crisis falls off the hot-off-the-press list of topics (in the media and research arena) as with Ebola (which is now a far, far away and distant memory), will we simply move onto the next crisis instead of resolving our systemic issues? And is this why, despite research and donor funding, we still have ailing systems? The 94+ / #LifeEsidimeni crisis is an indicator of the systemic issues which persist in the SA health sector i.e. poor quality of patient care, huge inequities, …

And it is a marker of what is yet to come if we, being politically correct, fail to address the massive public-private divide in the country and continue to move from one “hot” topic and buzzword to another.

That aside, the greatest success of the EV programme is that it is now being run by alumni, this year (#ev4gh16) was largely coordinated and spearheaded by EVs based at the Institute of Public Health, Bangaluru. EV alumni are also roped into all phases of the programme to provide mentorship, be facilitators and essentially assist with sustaining the initiative. As a “well- matured” facilitator, I joined the face-to-face action on Friday 10 November – a rehearsal day for EVs to finalise their presentations both for the signature EV pre-conference and for the Global Symposia!  A recurrent theme throughout many conferences or in our workplaces is what TEDx speaker David DJ Phillips has dubbed ‘Death by PowerPoint’- which many of us (if we’re honest) can also identify with – dazed, tortured, vengeful presentations! Thank goodness for the EV programme which attempts at training and equipping researchers with communication skills (oral or poster presentations and debates)! In 2014, I recall being trained on the Petcha Kutcha presentation style i.e. an approach which advocates for the use of minimal text and extensive use of images coupled with powerful messages and points. The Petcha Kutcha approach taught at the EV programme is aligned to one of DJ Phillips key messages of having the audience ‘actually listen to you’ instead of reading your slides. There are many different ranges of attention span which have been researched, although it seems as if it is all about the number seven, which we have to get right! Research indicates that if individuals in the audience are uninterested it takes just seven seconds (yes read that again, just seven seconds) for these individuals to stop listening, and if you are able to hold their attention you have just seven minutes to do so!

This year EVs were grouped into six thematic areas, namely; equity, health systems strengthening, implementation research, resilience and responsiveness, power and policy.  At the EV rehearsals, I sat through a wide range of topics, including malaria, health financing, Community Health Workers (CHWs) and even the Women in Global Health Initiative. Usually and unless I am watching the latest season of Suites or Zoo on Netflix, the seven second rule around attention-span would apply to me. However, I was once again reminded of the value of the EV face-to-face training, in refining presentations in terms of its necessary content which should be placed on a slide and the importance of powerful deliveries or narratives of research rather than the conventional – introduction, literature, findings. I recall all other communications/ oral skills building training I received over the years with often conflicting advice e.g. add more text people won’t follow what you are saying versus another workshop where advised, don’t add text, pictures are better! Oh the dilemmas of complexity and just around PowerPoint presentations, which despite attending various trainings we still tend to deliver Death by PowerPoints! Personally, the turning point in presentation skills and training was attending the EV face-to-face training in 2014, which encouraged researchers to be reflective of current academic practice and its associated communication as well as be innovative! This was evident at the EV rehearsal today and which we need to build on.

EV2016 Faraz Khalid – Powerful Slide Depicting Persistent Challenges of Provincial Autonomy in the Pakistani Health System

The EV programme is different in that besides offering mentorship and guidance it also allows for a strong component of peer learning, review and support. Each EV provided critical input and advice to their peers during their presentation rehearsals. The rehearsals today had the added advantage of being facilitated by two communication experts, Sophie Marsden and Vivienne Benson from the Institute of Development Studies (IDS), who offered some food for thought as we reflect on the type of presentations we deliver and useful tips for those still preparing or refining their presentations for HSR2016!

Tip 1 – You have to immediately capture your audience’s attention!

Tip 2 – The audience must know upfront what your topic/ focus is and keep it simple.

Tip 3 – What do you want people to remember from your presentation i.e. what are the messages you want to convey?

Tip 4 – Images from your research/ visualisations tell a story and bring the presentation to life, where possible try to insert them.

In summary, the presentation should have a punchy beginning; catchy titles and images are welcome, not forgetting powerful take home messages! Perhaps we will even move towards a stage of transcending disciplinary boundaries by inviting the likes of Steven Spielberg and Christopher Nolan for tips, because it really is about lights, camera, action and holding the audience’s attention while you truly communicate your research i.e. allowing for further listening and engagement or even the ultimate and most important aim – implementation! For now, while Hollywood lessons around narrative training or presenting your research in a riveting way for seven minutes remains far-off, you can instead attend #HSR2016 Satellite Session, 14^th November (09:00-12:00), Room 2, ‘out of the library and into the world: communications for research’ or simply apply for the next EV venture and its invaluable training, #EV2018!

I must admit, a few years ago, it would have been difficult to gather the courage to engage with a senior colleague sitting right next to me; things have changed, I’ve learnt that there is great power in engaging with the person next to you – this is perhaps the single and most practical networking tip I’ve come across and now use. After exchanging pleasantries with Moeketsi Modisenyane at lunch, I found he has had experience with being an executive member on PHASA, and is the current Director of Global Health at the National Department of Health, South Africa. Without a doubt, the conversation was fascinating and shifted from pleasantries, to the content of the conference, and on to the glaring gap between research, policy-making and practice. I had to ask Mr. Modisenyane if I could write on some aspects of our riveting conversation, which I must state at the onset doesn’t necessarily follow standard research procedure. It does certainly give us food for thought in our accepted ‘way of life’ a.k.a. our conventional academic settings, and of course a few lessons from Cuba.

Moving beyond our comfort zones- standard academic practice

When one engages in the research arena, there is an acknowledgement that presenters/researchers have the power to contribute to potential change; however this is rarely the case, as the majority of policy-makers tend to view conferences as a platform for academics speaking to each other with little consideration on the impact of the research and translation to practice.  The issue in many conferences and gatherings is also the content of the (presented) research which claims to be relevant, yet often leaves policy-makers in the room without a clear set of priorities. Often we neglect to indicate why and how research can be [realistically] implemented.

So we discussed the poorly set-out recommendations which as presenters, we tend to add as a slide at the end of our PowerPoint presentation – at the point when we are often rushing to complete the presentation, instead of engaging with, and convincing policy-makers of the exact action/decision they may take. This could be indicative of the lack of emphasis we place on this critical aspect of our presentation and research. Our recommendations should perhaps be the heart and soul of our work and presentations, instead of as a standard academic requirement to be fulfilled to make our studies look relevant. Are our studies relevant? To whom? To further compound the problem, even when recommendations are useful, presentations on a similar topic in the same conference may even provide conflicting evidence and recommendations!

Transformation – the mode of learning and interaction

While academics may be blamed for staying in their ‘comfort zone’, this is indicative of a broader  issue- of the type of training (e.g. university training) received, which largely focusses on reaching out to our peers and ensuring their understanding, instead of engaging key decision-makers and implementers. In fact, the theme of PHASA 2016 was centered on transforming public health education and practice. However, it is highly unlikely that the focus of a conference alone can transform practice, as Mr. Modisenyane rightly pointed out that even though an imminent gap between research and implementation exists, transformation is unlikely in a system, particularly when the ‘untransformed’ are attempting to drive this. The barriers to making this shift remain difficult, considering that it is embedded within a larger global system of accepted and expected academic practice. Mr. Modisenyane advised, “It is time to start with small, quick-wins, which will require us to shift the boxes a little with every opportunity we have,” be it in our daily activities or gatherings and even in conference settings.  While conferences such as PHASA 2016 attempt to include policy-makers, the actual translation to practice may still be questionable given the difficulty outlined by these key individuals when it comes to implementable ideas and solutions.

Globally, it is encouraging to see that there have been some strides towards policy-engagement and knowledge translation, an excellent example of this was the 2016 Women Deliver Conference in Copenhagen, which involved the use of cinema to convey key messages to a wider audience – trust me it, really worked! The Alliance for Health Policy Systems Research call and support for decision-makers at all levels of the health system (national, provincial) to attend the Fourth Global Symposium on Health Systems Research (HSR2016) in Vancouver later this year, is another such example. The Resilient and Responsive Health System Project (RESYST) is geared towards improving governance in the local level of health systems in countries such as South Africa, Nigeria and Kenya. At the last Global Symposium, actual decision-makers were fully funded to attend and participate in organised sessions, and the same will be the case in Vancouver.

Despite some of these successes, the tendency to rely on traditional methods of dissemination (e.g. policy briefs, and journal articles) to implementers continues. Interestingly, Mr. Modisenyane did not outline any of these mechanisms, but recounted his experience of visiting Cuba several times and seeing at first-hand the efficiencies of the country’s health and education system. These lessons, such as those from the Cuban experience appeared to have a more profound imprint on his perceptions and actions as a policy-maker. For example, he recounted that despite international sanctions, the Cubans developed a preventive system which is quick to respond to public health issues i.e. health professionals continuously visit communities to ensure they have access to care and that their health needs are met, instead of patients struggling to access care. Moving forward, we need to think more around actual policy and practical impact; it seems if we support decision-makers in visiting well-established health systems, it could have more impact on mindsets, experiences and may possibly also shape longer-term policy decisions.

Take home message – shifting the dynamics, reaching out to stakeholders

Our discussion was useful at two levels – the first, those of us involved in the academic arena are urgently required to take a step back, reflect and re-think the purpose of our work, and whether or not we are serious about engaging stakeholders. If so, it’s about time we re-look how we go about this. The second is that too often ‘the youth’ play a token role in high-level events, including conferences. That is unacceptable. We are often invited to give nice short speeches amongst ourselves, and then nod our heads and let the ‘big boys & girls’ take over. That needs to change, soon. We are more than able to get to the very root cause of issues and engage policy makers. In fact, I attribute my ability to reach out to policy makers to being given the right sort of ‘critical and innovative thinking’ training e.g. the Emerging Voices for Global Health (EV4GH) programme, and I’m even more enthusiastic about the role youth can play in SA and beyond, and especially after meeting another EV (2016), during the conference, André Van Rensberg (#ev4gh)!

Coming back to the current edition of the EV program, this year, we received a whopping 200+ applications from all corners of the globe which definitely gave selectors a few migraines and areas of contention! After much debate and too many tough choices, the EV team is excited to announce 41 outstanding candidates. The world will have to watch closely, perhaps even more closely than for the (s)election of the next United Nations (UN) Secretary General and next US president because just as in previous editions, EVs usually storm  HSG conferences  and the world in general! This year’s selection of EVs includes young health systems researchers, complemented by decision-makers and practitioners who are also considered to be activists in the field of health policy and systems research, and are passionate about health equity. It seems our selections for 2016 were also spot on: by way of example, EV2016 Dr Isabel Kazanga is already creating those resilient, responsive waves, including in national newspapers! Others will no doubt follow suit in the coming months.

So, what makes the EV programme stand apart from other capacity building initiatives?

Together with several partners, IPH and ITM train and build capacity and foster a network of young-and-upcoming researchers from the Global South. The programme is structured into two phases: an online distance learning phase, and face-to-face interaction conducted ahead of the biennial Global Symposium on Health Systems Research (which takes place this year in Vancouver). Linking the programme to the Symposium has been beneficial in enabling EVs to be part of the broader HPSR network and participate in HSG structures including the EV TWG! This year most of the EV action will primarily take place between August and November, and of course at the symposium itself! But also beyond the symposium, you’ll continue to hear from EVs, history teaches us. Some can’t even shut up !

Nothing’s ever perfect!

While the EV programme has made significant strides in bringing together young researchers from every corner of the globe, be it Cambodia, the Middle-East or Uganda, and although we’ve had quite some French and Spanish speaking participants in the past, we did not see a high number of applications from these contexts. The same is true for the post-Soviet Union countries. The challenge remains as to how we can expand the programme to further engage these speakers and tailor the training to their needs as well as bridge the language barrier in our programme and the broader research world! Also, of course, just as with any good cause, funding constraints have proven to be a challenge in ensuring that the programme itself takes place!  Although finances have not, and never will restrain us (EV4GH are, by definition, “resilient”), we are solution-driven – post the programme after all! Keep an eye out for all our EV action, including our emerged voices, EV2016 candidates and our exciting line-up before, during HSR2016 and beyond!

p.s. if you are in Vancouver on the 12^th of November 2016, do attend our EV pre-conference in partnership with the Global Health Students and Young Professionals Summit (GHSYP), Simon Fraser University! More details to follow soon!

I must say as a South African (SA) I was so proud to see AIDS2016 taking place in the beautiful city of Durban on Mandela Day, it added the much needed Mandela Magic despite him no longer being with us – who can forget that he was the one of the few political leaders of our time who openly supported the battle against HIV/AIDS. It is remarkable how the IAC has grown substantially to over 20,000 participants inclusive and representative of many countries around the world! Most exciting was for the nation and world to remember the young AIDS activist and icon Nkosi Johnson, whose demeanour, work and tragic story of dying at just 12 years old can and should never be forgotten! I have to say that Melania Trump might not admit her plagiarism (oh if she consulted with an academic, she could have gotten away with it by citing it) instead her speech made bigger waves on social media with the unintended consequence of overshadowing the great opening delivery of AIDS2016 by the dazzling actress and United Nations Messenger for Peace (Hollywood), Charlize Theron.  Theron was quite provocative in arguing that she was disappointed that South Africa had to host the IAC 21 years on, and a second time round. She went on to highlight , “we have the tools to fight HIV/AIDS… the problem is that… we value some lives over others… men over women… rich over poor… white over black!” Theron also threw out statistics which are difficult to fathom, last year (2015) 2.1 million people died from HIV/AIDS, of whom 180,000 were from SA!

AIDS2016 also saw other big names, from UN Secretary-General Ban Ki Moon attending along with Bill Gates, who addressed the conference. Gates spoke on the issue of funding which is there for the fight against HIV/AIDS, but highlighted the need for implementation and execution (p.s. we agree Bill, though we worry about the fragmentation and the, oh so ‘noble’ intentions)! In my personal opinion the most exciting aspect of a conference is to follow the work (ACTION) of civil society organisations (CSO), and this blog would not be complete if I didn’t consider SA’s Treatment Action Campaign (TAC). The TAC have made historic and momentous strides in the battle against HIV/AIDS especially with their life-changing Antiretroviral therapy (ART) Campaign in the year 2000. The TAC together, with its partner organisations did not disappoint, they marched on the 18^th of July at the IAC2016 demanding:

1. All people living with HIV need access to quality comprehensive HIV treatment now!
2. No healthcare without healthcare workers and a functional public healthcare system!
3. No more patents on medicine!
4. No more discrimination and criminalisation of key populations!
5. Increase funding for the global AIDS response!

I must admit I also haven’t slept very well over the last few years; reason-being that despite the value and change that TAC has brought to HIV/AIDS and other important health battles such as silicosis court battles of mine-workers (thwarting mining capital in the country), it is unacceptable to hear of their struggle for funding – “Dear Bill Clinton and other prolific funders, perhaps it’s time to fund those who fight for action like the TAC”! Oh, if only we academics and researchers could ‘demand’ and use the likes of exclamation marks in our writing we might not be having the 21^st IAC!

Another interesting article to read would be the Open Society Foundation’s piece on how SA cleaned the streets of Durban of homeless people, sex-workers, drug dealers and sex-workers ahead of AIDS2016 – a conference which is meant to deal with these very ‘vulnerable populations.’ So much for inclusivity! I’m optimistic this time around though, with the best innovation the stylish couture ‘red condom dresses’ showcased during the conference!

P.S. there you have it and it’s almost as if I were there! Although if you don’t trust me do follow our @ev4gh twitter page for live coverage from EV alumni Hyacinthe Kankeu, Solomon Huruva and EV communications representative Bolanle Banigbe!

It’s always exciting to attend large global gatherings such as #WD2016, particularly so this time, with the focus on the Sustainable Development Goals (perhaps Sustainable Development Girls – judging by the number of female participants in the images online! where are the men?).  SDG#5 (Gender Equality) was the focus of the conference, but the intersectional nature of the SDGs allowed for the conference to touch upon the others as well. Such gatherings always provide an invaluable space for meeting a range of very diverse individuals. You get to learn about different countries, work and projects at first hand – invaluable for global health, and much more effective than reading about these online!  What I definitely enjoyed was having the opportunity for quick effective learning – learning about new and creative innovations which I could take back home for immediate use or find ways of using such innovations in the future.

Youth Rocking #WD2016!

Innovative Conference Formats

Multimedia was given its due at #WD2016 which boasted an Arts and Cinema corner – a place where films were screened throughout the day. Films from across the world, particularly the global South were screened. They were riveting; in fact I would go as far as saying is that I absorbed much information through watching these films. In the short space of two hours I witnessed the unacceptable mass sterilization of migrants in the United States, an unfair judicial system in Mexico especially around the abuse of women, and the heartbreaking needs of many children in Uganda affected by the nodding syndrome.  If it were up to me, I would have the films screened in an IMAX theatre with pop-corn during the conference! You never know, we might see a rise of health-systems directors, actors and actresses who finally bridge the researcher-policy gap.

A giant turd sure is a good way to draw attention to the critical role of water in our lives! I first spotted WaterAid International by their #Pooselfies with a walking blob of poo in the exhibition hall. Their session provocatively posed questions around imagining giving birth without #hygiene #sanitation – and let’s face it, water is the most basic component of human life and our health system. It is now given substantial attention under #SDG 6 (Water & Sanitation). They also screened a list of great films with powerful messages.

#PooPicture – (Shakira’s First World Problems- I need to find out if it’s real poo, I didn’t get a chance to ask that – sure didn’t smell like poo!)

If the poo wasn’t exciting enough, the Menstruation Tent in the exhibition hall provided training in a tent, illustrating how a few pillows could provide a safe environment to discuss menstruation challenges! It felt different, it was different and facilitated an excellent flow of communication around menstruation issues, e.g. the sort of sanitary pads women in rural Malawi wear (with even blankets shaped as nappies), how in India, and indeed in many poor parts of the world, women make use of anything absorbent e.g.  hair, leaves or sand to manage menstruation, and of course the “never talked about” issue #menopause. We were taken through the menstruation wheel tool & pledged our support to the cause! I quite like the tent idea for youth engagement and possibly just about anything else! I also think the menstrual cup chandelier or #shechandelier would be an apt addition to the tent!

Critical Discussions at #WD2016

Sessions and plenaries were held throughout the day on sexual and reproductive issues ranging from abortion, UHC, the SDGs and even financing particularly meant for Women and Girls (enter the Global Financing Facility- GFF). Stakeholders and people present were all very enthusiastic about SDG 5. Not sure “the world out there” is on the same page (yet)…

But the data revolution aware of ‘gender’ made waves during the conference when Melinda Gates announced that there would be $80 million committed to improving data collection! While I agree with the need for data, particularly from a demographer’s point of view, one thing I would like to see is perhaps not a complete overhaul but an attempt to address significant gaps especially around vulnerable populations e.g. women with disabilities whose reproductive health rights are severely overlooked.

I must say though, that the world seems to be suffering from MDG amnesia. Our discussions seem to have started anew. A clean slate with little discussion around what was achieved under the MDGs, our mistakes, lessons learnt and how to build from there. Acknowledging and addressing the gap between the MDGs and SDGs is somewhat already set in motion, but I think we need to possibly take a step back to take a step forward. In fact, I felt the youth may be more conscious of this – #WD2016 youth scholars Anshul Kastor  and Shanza Ali were discussing failures of the MDGs, such as how achieving quantitative statistics in Bangladesh hasn’t translated to reality! Catch the Youth For Change Video interview on #SDGS. This amnesia extended to the Zika virus, which could also be tackled drawing in lessons from malaria, but it seems that even high-level panelists wanted to start on a clean slate and forget the not-so distant past!

Again, while commitments were made, there was a sense of trying to find solutions, but how concrete they are is yet to be seen! The GFF, which promises improved accountability and financing of the under-resourced global South, is thought of as a magic-bullet to address financing issues especially around women and girls, but its promises are a far cry from the reality I’ve seen during my doctoral research around financial management. We’ve learnt,  at least in the South African context, bureaucracy, lack of necessary equipment, and skills or even decision-making power are some of the important considerations, which I’m not sure the GFF alone will resolve. Again moral leadership is probably needed more in our countries; perhaps if I may suggest, ‘Dear GFF’ please help us tackle corruption before sending any more funds our way!

But we have to start somewhere and I think with the mix of attendees to #WD2016 we might actually achieve our goals! Perhaps you could all start by committing to the Deliver for Good Initiative ! Other highlights of the week included the launch of the UHC Initiative by the Elders and the Cultural Evening at the beautiful Tivoli Gardens on Wednesday 18th May, one of the best social events I’ve ever seen – from watching a beautiful Danish show, strolling through the gardens and letting our hair down! In addition to having compulsory cinema corners at every conference, from now on all social events should be held at amusement parks (#Young Dictator)!

Lastly and the most important update of all, I posed that I be offered the job of the Director General of the World Health Organization on social media (no response has been received as yet, but let’s not be pessimistic! No news is good news! And someone will eventually notice).  It’s time for a ‘Sustainable Development Girl’ such as myself to be at the very top of the Global Health Architecture!

I suppose I should be the last person to write on this, I’m probably still too young, starry-eyed and shy (yes we all have that shy gene and I don’t think it ever goes away!). I recall meeting several high-profiled people when I was much younger, well and recently, and let’s just say that I was more star-struck than anything else and I’d much rather forget about ‘looking like a tree’ than harp on it.  We as young people are not really taught ‘how to network’ (although I must admit I haven’t explored how we could be taught to network, the internet is, of course, full of information on this – most not very usable). When we do, eventually, take that networking plunge, we tend to encounter seniors who are cold, condescending and actually uninterested. Though I do suppose ‘networking’ isn’t too difficult these days, many of us merely ask ‘can I take a selfie’ and then, of course, pass it off as networking – (p.s. not that I’m judging, selfies are probably better than nothing, though I’m not sure as to how  we will achieve the #SDGS with it!).

Attending large conferences with 5000+ people such as #WD2016 or even Health Systems Global can be intimidating. Just think back to the conferences you’ve attended, either high profiled guests are surrounded by bodyguards, i.e. a dead end street to networking. Seniors tend to huddle together which leaves us mingling with each other – and trust me I think that’s great! It took me a while to realize that it’s not the famous or infamous people who matter, but that we engage with each other. We are the generation which must achieve the #SDGs,and the conversations we have must equal action. These conversations and interactions are possibly more useful than the business cards which are given out. When e-mails are sent to our business card contacts, we young people, are duly (99% of the time) ignored! In fact I can say, without a doubt, that every young person I have come across is 10 times more interesting than a panel discussion or a journal article for that matter. I’ve also learnt that you just have to take that risk, ignore that shy gene and merely greet/ introduce yourself. It definitely goes a long way! Networking is pretty easy when you’re named ‘Shakira’ I can basically hear waka waka going on in other persons mind which is then followed by, “oh! Like the singer.” It would be useful to have an emoticon I could insert right now! Jokes aside, golden words of wisdom were shared  Monday’s #WD2016 youth pre-conference, where Joy Murini  advised that egos should be removed to address the generation gap. I have been quite impressed with my interactions with some young people in the build-up to-and-during #WD. There are three individuals who I believe more senior researchers or policy makers should take a few lessons from:

Ahead of #WD2016 we were invited to lunch at the Danish Embassy where I had the opportunity to meet Minister of Women in South Africa (SA) Susan Shabangu who really took the time and  interest to listen and advise each participant (now that’s definitely rare).

Of course then there’s the down-to-earth Sandra Millar, founder of Dignity Dreams in SA (promotes the use of reusable sanitary pads).  I met Sandra at the embassy, and it has been an on-going engagement. That I think is critical to creating the next generation of leaders, i.e. continued mentorship and engagement, versus once-off engagements. In the #HPSR field we keep trying to read, understand and debate as to how we influence policy-makers in fact I am certain this will be the case for many years to come. Whereas, Sandra stood up during the introduction round and said, “Finally! I’ve been dying to speak, and waiting for this moment all my life,” and then went on to throw the sanitary towels on the lunch table and pretty much at the Minister. Maybe my problem is that I’m possibly too action-oriented, but did she get all the policymakers attention (though this is not a suggestion or permission to throw your research around)! Sandra also ensures that people never forget her, she sends an inspirational quote about women every week to every one of her contacts and what’s most welcome is the way she builds relationships and extends appreciation for the tweets & retweets (which really isn’t much)! Wow I think it’s about time we learn more from civil society in the #HPSR field, and we #BeLikeSandra!

During #WD2016 I also enjoyed an inspiring lunch with Dr Samukeliso Dube, Business Development Manager of Southern Africa who requested to meet with me (instead of the usual other way around) during #WD2016 to discuss Integrated PHC care and how we could take the work forward.

Some food for thought for seniors help us deal with our ‘conference/networking fears’ and perhaps approach young people at conferences – adopt us for a few hours during the conference as it is clear that it is not only the youth (and their shy genes) which are to blame for this gap in communication. This does exist. It must be and can be addressed! I don’t think we should wait for the next Women Deliver, how about we start this right away!

Women Deliver Scholarship Recipients Didn’t have to feel like this

I’m sure many of us are familiar with the feeling of being accepted to a conference and then having to find funding for it. In fact it’s almost next to impossible to be part of development conversations without the necessary funding. The great thing about being a Women Deliver scholarship recipient is if you’re selected as one of 200 youth from over 5000 applications you get to have a fully-funded experience! Definitely a dream come true and an unimaginable opportunity for many, including myself.

#WD2016 kicked off with an exciting youth pre-conference which brought together over 500 young people. Although I did feel there could have been more space provided for other young people to speak and interact with each other, I can identify with the organisers dilemmas of bringing together these high-profiled young people to the conference, which is complicated enough, and then trying to involve them in any speaking roles over the next 3-4 day period. That sounds like anything but easy. Nonetheless I’d say it needs to be considered and improved going forward not just at Women Deliver but at all conferences, i.e. meaningful youth engagement. This might also be a personal opinion – to have the opportunity of greater engagement and interaction, instead of listening to what is already known.

Though I must give credit where deserved.  The generation gap was highlighted by the Executive Director of Corporate Contributions, Johnson & Johnson, Joy Marini; the vibrant facilitator, Al-Jazeera’s Femi Oke (who was asking exactly what was on my mind), and Kate Gilmore (United Nation High Commission on Human Rights) who won many hearts. She began trending with #Handover saying that she would like to see someone younger than 25 take up her post. Hmm I wonder if this has been considered for the upcoming post of WHO’s Director-General! Nonetheless, I also think that the network built before and during the conference has been fantastic!

The opening ceremony had a stellar, when I say stellar I mean stellar cast featuring Women          Deliver’s Katja Iversen, Jill Sheffield, Dr. Babatunde Osotimehin and Dr Margaret Chan. It was    chilling and hard-hitting to listen to how rape cases continue to be treated in India along with the  unjust stigmatisation and victimisation, issues which are also present and relevant across the world.  Margaret Chan revealed that she once used to administer contraceptives in Hong Kong, and that the  #Zika virus is currently what keeps her up at night. It was a riveting discussion around why the United  States has failed to elect a female president, Afghanistan’s woes, in other settings why women are  probably more afraid of ageing than other pressing sexual and reproductive health issues, and last,  but not least, the role of men (yes of course there is a role for men) in moving forward! There was a  heart rendering account by Katja Iversen herself who explained that her grandmother grew up  extremely poor,  worked as a domestic worker to pay for her brother and husband’s education but  never realised her own dream of an education, although did live to see (quite proudly) Katja  graduate from university. What impressed me most was the Women Deliver team’s emphasis on  being solution-driven throughout the day, which is rare. It will be interesting to see how this  component actually plays out over the next few days. On my side it’s certainly camera’s rolling, take  1, and action! If you’re into being action oriented perhaps you could commit to the Deliver for Good initiative which is at the centre of #WD2016!

Boosting one’s ability and confidence to become a bold researcher and advocate for health equity – either on stage in a room full of big shots, or in (peer reviewed & more casual) writing – is one of the key aims of the Emerging Voices programme. It is probably also needed now more than ever in the Global South! Earlier this week EV2010 Taufique Joarder (from Bangladesh) shared a similar view on the (first) EV venture in Montreux (on IHP):

“Every day, before the sessions, we used to have a debriefing session with the EV organizing team. I remember Wim Van Damme (founder of the EV programme and esteemed Professor) telling us, we were free to ask any intriguing or even provocative question, even to the point of causing embarrassment to the presenter in the conference”.  As Joarder recalls, EVs duly obliged!

Going back to my own EV experience, the distance learning stage (which usually takes about 2-3 months) prepared us for the 10-day face-to-face training in Cape Town which essentially taught us how to present in an innovative way – in fact the more innovative the better! It was the first time I was encouraged and appreciated for doing so (and taking risks in this respect) and this is precisely the reason why I continue to push for the EV cause! Embracing one’s creativity and zest for life, together with a supportive environment is exactly what’s needed to shape the future and build capacity in the field of health systems research! The training programme culminated in a ‘pre-conference’ of EVs, a few days before the symposium itself.

And oh yes, the programme also afforded me the opportunity to attend the Third Global Health Symposium in Cape Town, an opportunity which might never have materialized without being generously funded through the EV programme. I probably don’t give away a secret if I say that a health systems researcher should try to go to these biannual symposia at all cost. It’s a bit like going to Mecca for us (but then every two years, at least if you manage to break the bank).

The connections and opportunities extend well beyond the EV programme which is exactly why I’m writing this blog, or working with other EVs on numerous ventures! I think fellow EV Erlyn Macarayan (EV2014) pretty much sums it up in a recent video in which she describes us as an EV family.  I agree, Erlyn! The constant support, encouragement and critical insights from IPH Bangalore (the current EV secretariat), the ITM team and other EV alumni go a long way in supporting EVs to be change-makers in domestic settings and at the global level!

By the way, do join us for an upcoming twitter chat on Monday 14^th March if you have any questions on the application process. Do not miss out and visit http://www.ev4gh.net/. We certainly hope to see you in Vancouver #HSR2016!

If I didn’t manage to convince you yet to try your luck, I’m pretty sure EV (2010) alumnus Asmat Malik (and member of the current EV governance team) will:

“Being an EV will give you access to the fountain of youth: it allows you to stay young at heart even with ‘emerging’ grey hair! I reckon it’s better than botox. ”   (mind you, looks as if even the likes of Julio Frenk and David Sanders can still apply for the programme! (just kidding, guys – the EV age limit is 40…)

In short, if you want to be part of the cool cats (or fearless pitbulls, for the boys) of HSR, become an EV!

In June 2014, I was selected as a Future Leader at the European Development Days 2015 in Brussels. On a panel with the esteemed 69^th President of the United Nations General Assembly (UNGA)-Mr Sam Kutessa, I boldly advocated for a ‘United States of Africa’ and drew attention to the challenges Persons with Disabilities face when accessing healthcare.  Subsequent to the Development Days, Future Leaders were quite excited to receive a once in a lifetime invitation to the historic SDG Summit in New York (25th -27th September) signed and sealed by Mr Kutesa himself. (Yes a letter directly from the President of the General Assembly- PS I’m still reading the letter every day)!

In addition to attending the opening ceremony, I signed up for many health and disability related side-events, little did I know the immigrations line at John F Kennedy airport would be so long that I would miss these events! I’m really counting my lucky stars that I made it for the opening ceremony! At the crack of dawn, 193 youth from across the world gathered outside the spectacular UN headquarters in New York. The morning started off with a meet and greet with UN Youth Envoy’s Ahmad Alhendawi and Noble prize Winner Malala Yousafzai.

It was extremely exciting to enter, to be seated at the General Assembly and to be able to spot the likes of Angela Merkel – it really does reflect a changing world, where youth are now given the opportunity to be included in high level meetings (even if it is at a snail’s pace). Pope Francis touched on a number of issues ranging from hunger to poverty and ethnic minorities. Algelique Kidjo absolutely rocked the UNGA with her performance and breathed life into the ailing ceremony. I was really inspired by Malala who stated that the world cannot change itself, we need to change it! While Malala is a fantastic representative of the youth, I do feel that youth ‘participation’ was not on the scale that it should have been, and that ordinary young people attending the Summit should have been given a larger platform to truly shape the adoption of the SDGs.  Perhaps at the next SDG Summit, when I’m old, grey and in charge I will ensure youth inclusivity and actual participation! Nonetheless, it certainly was an exhilarating and treasured moment to be part of history when the SDGs were adopted in the assembly.

Overall, it seemed that refugees, climate change and inequality dominated the focus of the Summit. It was great to see that under the ‘inclusivity’ banner, Persons with Disabilities were considered as part of the SDGs. On the other hand it was as if Ebola had never even happened and health was a minor goal. The critique is that a lot of the side-events and rhetoric at the Summit seemed to suggest that the MDGs were achieved. This definitely isn’t the case. In my view the problems and challenges outlined at the Summit are all the same, and have been the same for several decades, even if there has been some progress. I am doubtful that the SDGs will actually be effectively achieved; however, as a young person I certainly do feel the responsibility of ensuring that the SDGs are action-oriented and implemented over the next 15 years, it might be all we’ve got considering that close to 170 nations adopted the SDGs!

“All animals (patients) are equal, it’s just that some are more equal than others”

I recently attended the Leadership Management and Governance Training for Health Systems Strengthening in Africa. The training is hosted by Amref Health Africa in Kenya. It was an exciting two weeks, during which I had the opportunity to interact with numerous senior level managers/ academics across Africa who offered on the ground insight into specific health systems challenges. As always when visiting another country, the highlight is visiting health facilities/ hospitals. Dare I say, we often get lost in the publication process or our research activities and tend to forget the realities on the ground especially those faced by healthcare providers and patients. As part of the Amref training, we were taken to the Kenyatta National Hospital (KNH).

Public area emergency unit

KNH is the oldest hospital in Kenya (it was founded in 1901 and became a state corporation in 1987). It is the largest referral and teaching hospital in the country which has a capacity of 1800 beds and has over 6000 staff members. The emergency unit reminded me of most of the public hospitals in South Africa (i.e. mostly the malfunctioning ones). One could see that front-line providers are trying their best. One of the hard-working doctors stated that while they try and provide care for everyone, in some cases patients stay up to two weeks in the emergency unit  due to lack of beds or they are referred back to the lower levels of care due to limited oxygen tanks. There were extremely long lines of people waiting to be treated, floors were cracked, walls unpainted and a terrible stench. These are the conditions under which providers have to work and under which patients have to wait. As an example of limited resources, up to 4 patients sometimes sleep on one bed in the orthopaedic unit. It wasn’t all doom and gloom, though. I must say the critical care unit was spotless and well-maintained. However, overall the stark contrast between the public and private wings of KNH cannot be ignored, because just a few floors up (high up where the wealthy usually reside), one enters the private wing of the hospital. Just as in most countries, you know when you’re in a “private” facility. The floors shine, the air is fresh and crisp, healthcare providers are happier, and there aren’t long lines to access care. Trust me you won’t even know that you’re in the same hospital!

Private lounge VIP room

The private wing is further divided into different classes, from the general private room to a VIP room. Yes, a private VIP room, in a hospital! Perhaps the VIP room is worth considering for your next trip to Kenya? Compliments of wealth of course, a VIP patient could enjoy a lounge, a massive bathroom (the Jacuzzi sort) and the room also includes excellent views of Nairobi. It was at this moment that I could not help but think of one of my favourite novels, George Orwell’s Animal Farm. Kenya alongside other developed and developing countries has been moving towards universal health coverage (UHC), yet there continues to be palpable inequity between the public and private sector as evidenced by differences within one hospital. It is worth noting that revenue generated from the private wing does go towards KNH as a whole, but still! Moreover, Kenya’s National Health Insurance Fund (NHIF) is a massive government scheme but only covers those who are employed. I’d argue that if we’re really trying to achieve UHC, all revenue generated should be equally distributed amongst all patients, and schemes should not exclude the unemployed/ people who need healthcare the most but cannot afford it. I must then pose this question: is UHC in our present day context really about ‘health for all’? Or is it about providing health for “all animals (patients), under the assumption that some will always be more equal than others, especially if they have money”?

View from Private wing

Still, I thoroughly enjoyed it. It struck me, that I was out in the middle of nowhere but every service imaginable was of high quality and at my fingertips. I felt almost like Kate Winslet in you-know-which-movie. Of course, there were downsides such as seasickness, long lines to get on board and a swarm of people (it’s not really as exotic and posh as it looks on the fancy website). Overall, though, these cruise liners are extremely well-coordinated, considering that there are approximately 2000 guests on board the MSC Opera, 728 staff members, 878 cabins and a gross tonnage of 59.058 tonnes. If you think about it, in terms of volumes, cruise ships are quite similar to hospitals. In South Africa for example, Chris Hani Baragwanath Hospital has approximately 3200 beds and 6760 staff members – this is around the size of some of the bigger MSC liners.

Now, even if do fancy a few guilty pleasures now and then, I’m no fan of the private sector. But there are times that we have to admire (or envy) how well some private sector entities and industries function. While we’re worried about water scarcity, MSC boasts impressive machinery which converts seawater into drinking water for their ships. These cruise liners don’t run at a loss or have problems with suppliers like many of our health facilities do, instead they’re able to stock up food and all the necessary supplies before setting sail. The liners have massive budgets and huge storage spaces including cold rooms on board. Every single guest is accounted for through a card system, and if you miss the ship (as I almost did) the liners can account for exactly who is missing. It literally is an impressive operation; staff are friendly, you are provided with an entertainment itinerary every morning, rooms are spotless and all 728 staff have uniforms which are dry-cleaned and pressed every day. Cruise ships are often in the middle of nowhere, yet you can order a newspaper of your choice. Ah, the wonders of capitalism!

I could not help but think, why is it that cruise ships can function so well in the middle of nowhere, yet many health systems on land do not function this well? A systematic review in PLOS medicine (2012) found that there is no evidence to back up claims that the private sector is more efficient and accountable in low and middle income countries (LMICs). But let’s not get into the debate around public sector versus private sector efficiencies here – we have plenty of health economists for that. I’m aware making a comparison between cruise liners and the health system is probably not methodologically sound, but sometimes one just has to break the rules especially where logic is concerned. Although I agree it is important to acknowledge differences in terms of resources, tax dodging capacity and the like between hospitals and cruise liners (or other very efficient private industries, like aviation), there are certainly some lessons around functioning and co-ordination which might be applicable in our never-ending quest to strengthen our health systems.  Perhaps it’s about getting answers to some of the following difficult questions:

• Why is it that a cruise liner serves approximately the same number of people as a hospital but functions so much better and provides quality services?
• How do cruise liners ensure guest satisfaction (at least if we forget about the Costa Concordia for a moment) yet many hospitals cannot ensure patient satisfaction?
• How is it that cruise liners have sufficient stock and necessary supplies on board, yet our health facilities face drug shortages?
• Why is a cruise liner spotless and many of our health facilities anything but? (The abundant sea water probably helps, but still…)
• What are some of the lessons or ethos of the private sector that the public sector needs to adopt?

Dare I say I think it is possible to cruise towards better health care, but for this to happen maybe we need to stop thinking of health systems as being complex and perhaps draw on some simple and logical lessons from well-functioning private entities such as cruise liners?

Ready for the guillotine!