Now that I am back at my desk in Stockholm I cannot stop thinking about the Global health systems symposium that I attended in Cape Town, maybe because it was my first! And of course I cannot and never will forget the great experience and knowledge gained being part of the Emerging Voices 2014, definitely a life changing experience not to mention the wonderful friends that I’m sure I will have for a long time.
As approximately 2000 participants descended on Cape Town for the symposium, I could not help but notice how well organized the conference was right down to the beautiful bags and their contents (although this didn’t come as a complete surprise as Lucy Gilson had mentioned during the EV face-to-face program that the careful selection of what was to go into the bags had been a venture in itself). If there was one downside, it was that I was spoilt for choice: as I looked at the daily program and had to choose between eight and sometimes even more concurrent sessions, I was slightly overwhelmed (and many EVs with me). This further emphasizes how much the health systems research community has grown.
Although we all attended different sessions, one could not help but feel the dark shadow that the Ebola epidemic raging in West Africa had cast, and more so a constant reminder of how important well-functioning health systems are. The Ebola outbreak continues to demonstrate to us that factors and people outside the health system also play a crucial role in health outcomes.
Hence the theme ‘People-centred health systems’ has taken on a life of its own. Sometimes it appears we’re damn good at not learning lessons from the past. ‘Lessons not learnt from the past’ should perhaps be a key ingredient of every scientific presentation at this kind of event.
Let me just give one example. Having realized several years ago as I worked in a rural district in Uganda that the ‘community/people’ should be part of a well-functioning health system, and many of my fellow emerging voices agreeing with me, we were disappointed at one of the concurrent sessions. The closing remarks from one of the main presentations were ‘We didn’t involve the community and one of the main lessons learnt was to involve the community’. I expected a lot of reaction on this statement as it seems to me that we learnt that lesson decades ago, also having been well articulated in the Alma-Ata Declaration of 1978. But as you might have guessed, in the year 2014, this closing statement did not draw any reaction. I had naively expected someone in the room to say maybe it’s time to start acting on the lessons we have learnt and seem to be learning over and over again? I dare say I did not say anything either (first timer…), which was a betrayal to my recent involvement as an ‘emerging voice’, or should I say emerged at this point?!
Back to the ‘no reaction’, I wondered if the organization that made the presentation had anything to do with it (a multilateral, very influential organization funding both health research and implementation). It led me to think about the politics within health systems and how this has led to ‘learning lessons over and over again’ and what seems to be a lack of (or not enough) ‘action’ ( from a first timer’s point of view!), or worse. Nevertheless I was delighted and encouraged by the remark made by Martin McKee during one of the plenary sessions about bringing the right people to the centre of the health system. I hope in some way that will be involving the community in the health system as we move the People Centred Health Care agenda forward.
The ongoing Ebola epidemic in West Africa has made the importance of the social fabric in health systems even more apparent, as safe burial and community sensitization are one of the five strategies to combat the current epidemic. How do we involve the community in order to build trust and not have only people from outside these communities involved in this sensitization? How do we fight the growing stigma around an epidemic that is so fatal? How do we get the people at the centre of this epidemic to understand the notion of ‘safe burials’ in the face of Ebola? These are some of the critical questions that may need to be answered as we grapple with the exposed weak health systems and move forward with the science and practice of people-centred health systems.
Looking forward to Vancouver 2016, I hope that by then we will have made significant progress in bringing the right people to the centre of the health system. And of course I want to be there again!