Key insights from the RESYST annual meeting
I am writing this from the second day of the RESYST annual meeting, which represents the culmination of this 8 -year programme of health policy and systems research, and a point where consortium members have gathered to review and reflect on experiences and achievements. I have been a member of the Consortium Advisory Group, and was asked to summarise what I took from the first day, which encompassed both discussions on knowledge generated through the research, and reflections on the functioning of the Consortium.
Historical origins of the current consortium
In 1990, I was fortunate to be offered the opportunity to establish the Health Economics and Financing Programme at the London School of Hygiene & Tropical Medicine, which with DFID support commenced a programme of research and capacity strengthening in health economics and financing. Over 3 successive 5 year funding periods, this programme developed long term collaborations with partners including in India, Nigeria, South Africa, Tanzania, and Thailand, and a wider network through the Public- Private Mix network. These original collaborations continue to this day, if now largely with new generations of researchers at those institutions, and new partners have joined. In 2005, DFID changed its funding mode to Research Programme Consortia, and supported the Consortium for Research on Equitable Health Systems (CREHS) from 2005 to 2010, and RESYST from 2010 to 2018. With the RPC model, the relationships with partners were formalised and more strongly structured, ensuring distributed leadership across the consortium.
Growth in health policy and systems research
Reflecting back to 1990, there has been incredible growth both of the field of health policy and systems research and of the partners engaged in the Consortia. There has been a huge increase in the numbers, skills and expertise of researchers and in knowledge gained on health systems and policy. Within the Consortia we have seen researchers grow from junior research assistants, though PhD training to post doc experience and promotion to senior researcher. Those who were more experienced initially have developed as research leaders, some taking up positions as department or centre head, even vice-chancellor!
At this annual meeting I was struck by the diversity of the 45 RESYST researchers and decision makers - in terms of nationality, ethnicity, gender, age and seniority. I was also struck by the dynamic nature of the RESYST community, with a stable core over the 8 years but plenty of new blood drawn in over the period. There was universal recognition of the benefits of diversity, and the vibrant intellectual environment it facilitated.
I was also struck by the attention that had been devoted to ensuring the Consortium functioned in ways that were transparent, inclusive and supportive. Mechanisms included discussions of consortium functioning at each annual meeting (including, at this meeting, an opportunity to reflect on individual and organisational development over RESYST’s life), and an annual survey of members’ views. This care paid to consortium functioning and management is a huge collective credit to the management group and the leadership.
Benefits of long-term programme funding
It is important to stress that it is the funding mode that has underpinned this productive global community of researchers. Programme funding, with a broad agenda and money for capacity strengthening, communications, and policy engagement, has provided the long term security and stability needed to build relationships amongst researchers, with research users of all types including policy makers, and with the global community, providing intellectual and policy impact benefits way beyond those which would be possible through the same amount of funding spent via support of multiple projects.
Challenges faced by international research consortia
Any international consortium such as RESYST faces multiple challenges, and I would single out three. The first is characteristic of research endeavours seeking to draw lessons on health system functioning. Each country’s health system is different, and operates in a different context. To learn lessons we need to be able to study how and why a health system element functions in a particular way in a particular setting, and what aspects might be transferable elsewhere. RESYST has started looking over time at how a country such as Thailand developed the necessary capacities required for UHC, including political leadership and bureaucratic competencies. But we can also ask about the causes of the causes - how was it that, historically, Thailand has had, for example, an effective bureaucracy, capable of implementing public programmes across the country. Historical methods of enquiry, including approaches such as historical institutionalism and within that path dependency, can offer useful insights on the longer term dynamics of health system change. And the development of country capacity in health policy and systems research, such as that facilitated via RESYST, is a critical enabler for this type of in-depth research.
The second and third challenges relate more specifically to the functioning of consortia. Membership of a consortium is not a full time occupation. Members have other projects and networks, other responsibilities like teaching and administration, and of course personal lives. Despite these multiple pressures, consortium leadership needs to be capable of engaging the attention and commitment of members over the longer term, a capability which has been well demonstrated within RESYST.
The third challenge is that of a fixed period of funding – the consortium funding model does provide stability, but all good things come to an end and researchers move on, like I have done, to new challenges. RESYST is reflecting in its second day of meeting on how to sustain the individual and organisational learning after RESYST.
Celebrating the growth and development of RESYST researchers and their organisations
Finally, the annual meeting was a time for celebrating - celebrating the personal learning that has taken place, the influence on policy, and the satisfaction of being part of a flourishing and dynamic community of researchers. Individuals paired up to recount their personal stories of development, which were then distilled and summarised for the wider group. We heard amazing and inspiring stories of personal development. We also noted the other developments in people’s lives - for example a significant proportion of the participants becoming parents.
Substantial time within the meeting was allocated to lesson learning on policy engagement. Achieving impact on policy is a huge challenge, but consortium members were able to celebrate multiple examples where their research efforts had direct policy influence.
Looking to the final days of RESYST, it should be a priority to complete not just the academic papers, but also the accounts of Consortium functioning. We train young researchers in technical research skills, but we don’t focus enough on developing the softer skills needed to ensure the success of a collective research endeavour. RESYST has a rich set of learnings to share with the world on how consortia such as these can best be structured and managed. And it can demonstrate to research funders the knowledge generation, capacity strengthening, and policy impact achievements that are possible with stable, long term, programme funding.