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#EV2018 Distance Learning: Global Inequities in Health System Research & the Rise of Health Systems Agents of Change

By Shakira Choonara
on September 7, 2018

It’s that time where in South Africa and the Southern hemisphere, at least, there are blossoms everywhere and a spring in our step literally! Not to be corny, but this analogy does resonate with the Emerging Voices (#EV2018) distance learning phase which is the first stage to getting that health-system-spring-in-your-step, thoughts and actions as you reflect, learn, share and connect to disrupt the status quo in our field. EVs from the new “Liverpool batch” have been involved in distance coaching for about two months now. By the way, as I’ve gotten to know many of them better already, virtually, I hope the wicked UK authorities will show some mercy on their visa requests.

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.


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