I clearly remember the first Monday of 2015. At the time, I was in Germany on an India-Germany student exchange programme. Sitting in my cold dark room, I was contemplating the transdisciplinary nature of my PhD study focusing on development aid and health systems strengthening in India. With a medical and health administration background and (at the time) starting a PhD at a school of Social Sciences, health system issues were never really confined to specific “disciplines” to me as my quest towards any problem-solving endeavor was always driven by (research) ‘questions’. Arguably, this rather simplistic ‘question-driven’ approach posed me with some challenges in terms of finding a suitable multidisciplinary researcher title for myself.
Suddenly, I received a pop-up message on my desktop, announcing that I had been selected to join the inaugural KEYSTONE training course on Health Policy & Systems Research (HPSR) in India convened by the Public Health Foundation of India as a Nodal Institute of the Alliance for Health Policy & Systems Research (AHPSR), WHO. In an instant, I felt I want to be identified as an HPSR researcher. At the time, the label ‘Health Policy and Systems Researcher’ was just a title I wanted to attain. Now, however, as I am submitting my PhD thesis, I fully recognize that the pursuit of this title has given me so much clarity, not just in my writing but also in making appropriate career choices.
I immediately replied with my acceptance mail to join the course and soon started receiving introductory readings for the course. The following month in February, I joined the most enriching ten-day residential ‘KEYSTONE’ course in Delhi.
The KEYSTONE training course and its aftermath
I was particularly impressed with the efforts that had gone into designing the course and felt it held huge promise for developing context-specific HPSR training courses worldwide. The course involved almost all leading national organisations engaged in HPSR research and practice across India, including the Indian Institute of Health Management Research Jaipur, Indian Institute of Management Bangalore, Indian Institute of Public Health Gandhinagar, Indian Institute of Technology Madras, Institute of Public Health Bengaluru, Jawaharlal Nehru University, National Health Systems Resource Centre, Post Graduate Institute of Medical Education and Research Chandigarh, (the already mentioned convenor) Public Health Foundation of India, Public Health Resource Network, Society for Community Health Awareness, Research and Action, Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum, and Tata Institute of Social Sciences Mumbai. Not just the trainers but the twenty fellows also represented different academic/research organisations, government health departments, technical organisations and Non-Government Organisations from across the country.
Given the residential nature, diversity and expertise of the people in the workshop, those ten days were bound to be filled with rigorous HPSR training, wonderful sharing of experiences and cross learning amongst the fellows. For me, the biggest take away from that training was the community I immediately became an integral part of.
I realized we were all at the early/mid- stage(s) of our careers, having already found our focus but desiring peer support and a bit of hand-holding while marching on our journey as HPSR researchers. During the training, we were assigned individual mentors from the trainers’ group, who took time to understand our own ‘positioning’ in the health system & governance/policies. They helped us refine our approach to framing the problems which we found were plaguing the health system at various levels in India. By the end of the course, we all had developed a research proposal (which we presented to the key public health decision makers during the last day of our training) and hoped to receive both technical and financial support to carry out our research.
We left the training with a newfound desire for sustained mentorship and hopes for making a positive change in our health systems. Unfortunately, things did not go as planned afterwards. Like many other ‘long term mentorship and capacity building’ courses that face similar sustainability issues, Keystone could not retain the attention and resources it received at the start. So far, a second round has not materialized.
Perhaps, the (still) heavy focus in India (and elsewhere) on investing in bio-medical research and vertical health initiatives (as compared to supporting HPSR) had something to do with that. Beyond the lack of adequate financial support, other factors might also have played a role in this case, such as the issue of “ownership” of such a multi-stakeholder/institution initiative, (political) challenges faced by key institutes and organisations involved in Keystone (partly also because HPSR is intrinsically more ‘ideological’ than biomedical research), …
A call to action
Nonetheless, the bonds we (fellows) created during the training haven’t faded even a bit and in fact they have gotten stronger overtime. We kept discussing /debating through a WhatsApp group about the recent developments in India’s health sector and continued sharing about our work. Sometimes our paths crossed in some meetings or workshops like People’s Health Movement meetings, Health Systems Global (HSG) Asia regional workshops etc. When we meet, we never fail to take a selfie and share with the group to remind ourselves of the mission that we are on!
The (sad) irony is, on the one hand we currently see an alarmingly high number of applicants seeking support for HSG supported initiatives (like publication mentorship, or abstract strengthening in an HSG Asia workshop), screaming of an enormous will to work for improving health systems but faced with an unmet need for HPSR training; on the other hand, there is publicly available KEYSTONE course material and vast resources in terms of HPSR organisations and trainers (carrying out their mainstream health systems courses) which are not being effectively utilized for strengthening the (Indian and no doubt also broader) HPSR community.
Although outbreaks like Ebola or the new pandemic (COVID-19) keep reminding us of the importance of investing in more research to strengthen our health systems to manage such crises, as soon as we recover from these epidemics, life goes back to usual and health systems research continues to face the neglect. Perhaps amid the current global anxiety over COVID-19, with hundreds of millions and even billions flowing once again to biomedical research and (last-minute) propping up of health systems, we should take a moment to reflect: we are doing something fundamentally wrong by neglecting research for improving health policies.
Through this forum I would thus like to make a call to everyone associated with Keystone and other HPSR training courses throughout the world to come together in 2020, exactly five years since the inaugural training on Keystone, to plan and deliver a similar training programme (perhaps this time through a virtual platform?) to fill this persistent HPSR training gap and build a strong army of HPSR researchers. I would also like to urge all ‘funding partners’ who are now shedding billions to control COVID-19 to please consider investing in health systems research on a sustained basis to strengthen health systems as a whole because chances are this won’t be the last pandemic humanity faces.