Liverpool School of Tropical Medicine staff had a busy but productive week at the Global Symposium on Health Systems Research in Cape Town this week.
Ebola
One of the most important gatherings at the conference was an impromptu meeting on Ebola which was co-sponsored by the Thematic Working Group on Fragile and Conflict-Affected States and USAID. ReBUILD partner, Haja Wuriefrom the College of Medicine and Allied Health Sciences addressed a packed auditorium on health system research needs in Sierra Leone. She described a health system in devastating chaos,
“Fear of contracting the virus and high levels of mistrust have led both health workers and service users to abandon health facilities. Seeing their colleagues succumbing to the disease, ill-equipped health workers were understandably fearful of going to work. Victims and their families also avoided going to health facilities, as a result of rumours that spread of the virus was taking place there.”
It is hoped that this meeting was the start of a dialogue among the health systems community on how to respond to the immediate emergency, rebuild health systems affected by Ebola, and learn how to deal with crises in the future. Evidence from ReBUILD – showcased at the conference in posters, panels and presentations – offer guidance on how to reconstruct health systems after social or military conflict.
Improving health system governance
The PERFORM project hosted an interactive panel, “How can governance be strengthened in decentralised health systems? Lessons from Ghana, Tanzania and Uganda”. Tim Martineau opened with a description of the PERFORM which uses action research to improve district level health worker performance in Uganda, Ghana and Tanzania. Districts are central to health systems strengthening and in the panel Dyogo Nantamu, District Health Officer from Jinja, Uganda outlined his room for manoeuvre in changing practice. Patricia Akweongo, University of Ghana, discussed her experiences of supporting the facilitation of District Health Management Teams in problem analysis and identifying solutions within local contexts. The interactive session included experience sharing from a range of contexts including Papua New Guinea, Kenya and Rwanda. Dovlo Delanyo, from AFRO closed the session by stating that districts are the foci through which we can move health systems in positive directions.
People-centred health systems
The theme of the conference was how to create people-centred health systems. The REACHOUT Consortium, with its focus on close-to-community providers, or community health workers, in six countries was well placed to share important evidence in this area. An interactive, participatory session – chaired by Sally Theobald – enabled reflection on how to overcome challenges related to supervision, coordination, and referral. Other presentations covered issues like overcoming the split between vertical and horizontal health programmes and how to empower community health workers.
Gender and ethics lens
Lastly, LSTM was represented within RinGs – a project which is working to galvanise gender and ethics analysis within health systems research. This is an area where there is potential for growth. Eleanor MacPherson, who presented on her work on HIV and fishing communities at the conference, commented, “I’ve really enjoyed attending the conference and hearing gender discussed in both the plenaries and in dedicated panels. However, I still think there is still a long way to go. All too often at the conference gender has equated to women and their access to maternal health services. While, these are important component of any health system we need to ensure that research and health policies respond to the health needs of women, men, and people of other genders beyond this narrowly defined priority. I hope in future conferences to see a widening of this to encompass much more diversity.”