Can you identify 2 main challenges and opportunities for health systems research between now and the next global symposium in 2016 (or maybe beyond)?
Just two? Well naturally, the first topic that comes to mind is one at the heart of my work: the intersection of health systems and infectious disease research. We looked at this in a journal issue for the First Global Symposium on Health Systems Research, back in 2010, but it is still under-addressed. I think the global community’s response to infectious diseases in recent years presents some very important lessons relating to health systems dynamics.
During the first decade of the twenty-first century, the channelling of resources into disease-specific programmes, particularly HIV programmes, resulted in many activities happening outside of the national health systems that usually coordinate core functions such as health service delivery and health information management. This approach had its merits at the time. But in the long run, major progress has been made on some infectious diseases while others remain neglected. The fragmented response to infectious diseases needs to be transformed into a health system-based effort to address these health threats collectively, with due attention to how this work relates to other health system priorities.
My second response relates to the journal supplement on people-centred health systems, launched at the recent Third Global Symposium on Health Systems Research. In the words of the editors, the issue is: “putting people first in terms of how services are designed and delivered, and not merely orienting services on the basis of diseases, or for the convenience of clinicians”.
I recently had the opportunity to explore what this means in one specific context when I co-edited a journal supplement on hepatitis and drug use in Europe. A statement by a team of authors from drug user organisations in Spain sums it up perfectly:
Give us voice and respect, more often and in more situations, and we are sure that this will make a difference in the prevention of drug-related harm, including harm from the transmission of hepatitis C and other bloodborne viruses.
How can health systems researchers embrace and support this perspective? That is a key challenge I want to see addressed as the health systems field continues to develop.
How would you like to see health systems – from both research and operational perspectives – positioned in the post-2015 development goals?
Quite simply, I would say that if attention to health systems is not central, we will meet with the same failings that we had with the Millennium Development Goals. The trick is to address urgent issues and save lives, while also positioning ourselves for the long run. Smart health systems research and policy-making is really our only hope for achieving this critical balance.
You recently proposed some modifications to the WHO health system framework, and invited interested parties to share their thoughts. At what stage is the process now and what do you envisage/hope to be the overall outcome?
This was nothing less than a shocking exercise for me. What started as a discussion with a colleague and a short blog post, has turned into a global conversation with more than 20,000 views of the post in just 10 weeks. We are reviewing all of the responses and plan to write up the experience as a journal article. The goal is to help shape how researchers and planners frame their evolving understanding of health systems.
In reality, we believe that the new figure we are finalising represents a major shift that has occurred regarding how people think about health systems, but only a minor change to the building blocks themselves.
Finally. A little over 2 years since Health Systems Global was officially born, how has the society met or even exceeded your initial aims and expectations? And what excites you the most about the society’s work in the coming years?
It’s hard to know where to begin – we have more members than ever, a large symposium surplus to help us prepare for the Fourth Global Symposium and an engaged membership and health systems community. What I find exciting are the unanswered questions about how we will develop. When I co-founded Health Systems Global in 2012, our central goal was to run the global symposium. Now we have nine active thematic working groups and are heavily engaged in social media.
Where Health Systems Global goes from here will depend very much on the priorities that emerge from members’ ongoing discussions, both in thematic working groups and in other fora, and these priorities cannot be fixed in a static agenda. The health systems community’s response to the Ebola crisis is a good example of how unforeseen global events challenge us to think and work in new ways. Flexibility will be the watchword for Health Systems Global. I am eager to see how the organisation continues to dynamically reconfigure itself in accordance with the always-changing nature of health systems themselves.
Jeffrey V. Lazarus is a senior researcher at CHIP, the Centre for Health and Infectious Disease Research at the University of Copenhagen. He is the secretariat director of Health Systems Global. Follow him on Twitter at @JVLazarus.