Exco Health Care

The science and practice of people-centred health systems

Low-angle view of hospital sign.

Cape Town was abuzz with healthcare specialists from all over the world for the 3rd Global Health Systems Symposium. The conference theme kept up with current industry trends, looking at “People Centred Health Systems Research”. Interestingly, the word “People” alone sparked a debate. Who are the “People” we are referring to? Are they patients? Are they the community we serve? Are they the healthcare professionals? Who are they? And so the conference opened bringing together divergent thinking from Public health specialist, Academics, Development Partners, Policy Makers, Healthcare Professionals, Global Funds and Activist.

The conference set the precedence for a robust discussion on application based research, forcing contributors and participants to bring forth actionable research that could be interrogated, strengthened and then translated. What this highlighted for many is that, the community of practice is vast, there are so many examples of what to do and what not to do. This also highlights to us once again the structural complexity of delivering healthcare in dynamic environments. Experts are recognizing that there is a reason now more than ever to look for solutions outside the healthcare industry.

There was a great analogy made in the opening plenary: “Animals adapt to their environment but people change their environment.” Thus for meaningful transformation in the healthcare system we need the structures to change. Thus much of the focus of the conference was focused on transformation of the building blocks.

One of the most topical issues was Human Resource investment. This investment calls for the development of a much needed skilled workforce. Policy makers debated norms and standards for workforce to help create a conducive environment. Once again the leadership was top of mind, “We need courageous doers! – that will purposefully realize designed health reforms”.

It was rather alarming that the World Health Organisation (WHO) had to put out a press release condemning the rising violence against healthcare workers. It is unfair that front line healthcare workers lives are put at risk while they work to save others. “More than 2300 incidents involving serious acts or threats of violence in health-care settings between January 2012 and July 2014, but many more attacks go unreported”, according to the International Committee of Red Cross (World Health Organisation). Therefore there is a need for states to make a greater effort to protect healthcare workers.

Universal Health Coverage (UHC) is still top of agenda and there have been many recent implementations that were shared: Thailand, Ghana, Philippine, Mexico. It is worth looking into the World Bank report that provides a detailed analysis of UHC in 25 low and middle income countries. Daniel Cotlear, the Health Economist from the World Bank left a key message based on the analysis, “It is important for countries to stay the course if they decide to undertake UHC”. The analysis shows that this is not a quick fix and each implementation needs to be considered individually and amended based on evolving dynamics of the healthcare system in which it is implemented

It was personally motivating to have the Ministry of Health Director General of South Africa and her team all at the conference for sharing the journey that South Africa has embarked on since 2009 and the series of reforms being implemented in preparation for South Africa’s National Health Insurance implementation. The Deputy Director Generals also provided insight into some of the more recent work such as Operation Phakisa Ideal Clinic initiative that aims to take primary healthcare delivery to the next stage led by Jeannette Hunter. The CFO, Ian van Merwe has aligned Financial Performance to the Non-Negotiables and Dr. Terence Carter Deputy Director General for hospitals, Tertiary Services and Workforce gave confidence in the institutional reforms his team is driving.

There is energy and commitment now more than ever to drive reforms in the healthcare system by bringing patient needs to the forefront of delivery. There is a need to create an inclusive healthcare system so we forget about the boundaries of public and private healthcare. We need to open ourselves to the innovations of the 21st century in to create room for individuals, communities and nations to grow and develop. We need to be prepared to make healthcare a personal agenda, so much so that we can obtain multi-lateral commitments t that results in actions. The recent Ebola Pandemic has reminded us that healthcare service delivery is universal; we need to have a system that works.

About the author

David Graham

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