Earlier this week, while delivering the keynote address at the exciting Junior Public Health Association of South Africa (JuPHASA) 2016 conference, I touched upon the fact that it is rare for young individuals to truly be engaged in policy discussions. During the keynote, I also alluded to the importance of self-accountability and encouraged the youthful audience to track down and engage with seniors in the room. I must admit, that on my side, it was a sheer stroke of luck to be able to sit with senior members for lunch on day three of the Public Health Association of South Africa (PHASA) Conference (#PHASAUFH2016).
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)!