Putting people at the heart of the health system: The importance of research in building resilience and responsiveness at local level

July 2015
Shakira Choonara

On the 4th of June, 2015, RESYST Shakira Choonara, PhD fellow at the Centre for Health Policy in the Wits School of Public Health, participated in a high-level panel on ‘Defeating Ebola and Building Up Systems for a Better Future’, alongside WHO Director-General Dr Margaret Chan and other speakers involved in fighting the Ebola crisis in West Africa. The debate was part of the European Development Days 2015 and Shakira participated through the Future Leaders programme, which gives young people the opportunity to share their views and experiences in high-level debates and policy discussions.

In this blog, Shakira reflects on her experience of speaking alongside leading figures in Global Health, and shares her perspective on how health systems can be strengthened for a better future.

Tell us how you came to attend this meeting, and what your impressions were.

Being an alumnus of the Emerging Voices Programme, I receive calls such as the Future Leaders Programme. I had a look at previous videos of the European Development Days (EDD) and was impressed by the participation of young individuals in key discussions. I was particularly struck by the high-level representatives from across the world who attend the EDD. I thought participating in the EDD15 would be an excellent opportunity to contribute to critical discussions around the Sustainable Development Goals (SDGs) and the post-2015 development agenda.

Future leader applicants (aged 21-26) could express interest in any of the different areas of development (health, gender, job creation, climate change, migration). Being involved in RESYST and the call for health being linked to building resilient systems, I thought this was an excellent opportunity to contribute to the EDD panel discussion on Ebola. As part of the application process I made my first ever You-Tube video– all I had was just two minutes to summarise the RESYST project. There were so many inspiring individuals across the world who applied for the programme; I never imagined being selected as a Future Leader.

What do you think are the qualities of a future leader and why is it important to involve future leaders in discussions about global health issues such as Ebola?

Presently, a large number of leaders are motivated by power, wealth and status. This is not leadership. For me both future and current leaders need to serve those they represent. The world is in dire need of leaders who will boldly stand-up for what is right, display honesty and integrity and always be critical (critical of others and themselves).

Situations are constantly changing involving stakeholders such as the youth in global health discussions provides holistic insight into situations such as the Ebola outbreak. Including young individuals allows one to draw on young researcher’s experiences and perspectives, mould these young individuals to be the leaders of tomorrow and allow them to play a pivotal role in shaping decisions and discussions which will affect their future. More importantly future leaders represent young people around the world and through participation ensure that the ‘youth voice’ is heard. This is essential in tailoring health systems to meet community needs, in particular youth needs.

What role can researchers play in influencing health agendas and policies at national and international levels?

Research provides much needed insight into challenges and strategies for stakeholders across the health system, including policy-makers, district managers and the community. While we are struggling to find and solidify effective knowledge-translation practices, I do feel that researchers have a critical role to play in influencing stakeholders across all levels of the health system within the country and outside of our countries. I feel strongly that researchers need to be advocates and change-agents; we must find a way of identifying relevant stakeholders and communicating our research. It should however not stop at communication, as advocates we need to ensure that our research filters into policy formulation and implementation.

Building resilient health systems was a key theme of the session and much of the discussion focused on the need to strengthen systems so that they are better prepared to cope with health shocks such as Ebola and the international response. You also highlighted the importance of communities in building resilient health systems. Can you explain why communities are important?

Before I answer the actual question, I’d like to highlight that for a number of years, health policy and systems research has been geared towards ‘strengthening’ health systems/ creating these ‘resilient’ systems. As the world echoes the call to build resilient systems, there is much to be learnt from existing health policy and systems research and the need for more funding to be directed towards the field. Perhaps I’m biased but I feel that there is much to learn from the RESYST’s action research approach.

In line with building these resilient health systems, responsiveness is absolutely key - placing community needs particularly marginalised groups at the heart of the health system. Resilient systems must be responsive to health needs. Systems ultimately serve communities, if there are access barriers or stigma associated with diseases we see that facilities or health services are not utilised. At last year’s 3rd Global Health Symposium in Cape Town, there was a call to stop thinking of communities as ‘victims’. I agree, it is vital to think of communities as partners in our health system, as a resource on its own. We should make use of this important resource particularly the knowledge, experiences and skills of the community in building resilient health systems.

In her speech, Margaret Chan said that we are at a critical stage of the Ebola outbreak, where Liberia was making progress but hidden chains of transmission were still occurring in Guinea where there are still deaths occurring in the community instead of at an Ebola treatment centre. This indicates that patients are still unwilling to seek early treatment (or that case detection is not aggressive enough). Communities are still resistant to cooperating with response teams. What do you think the international community can do going forward to gain community trust, and what is the role for researchers in this?What we saw during the Ebola outbreak and in many other health programmes is that communities are always included as an after-thought. The most important lesson from the Ebola outbreak is that community involvement was key in fighting the outbreak. If we are to gain communities trust we need to include communities at the project development/ research protocol phase. By truly achieving community inclusion we will ensure that communities are able to mobilise and assist with strengthening the health system and fighting outbreaks.   

As mentioned before we need to draw on the community as a resource, consider communities to be our partners and make use of innovative methods such as action-research approaches geared towards strengthening the implementation level/ local level of the health system (and there is certainly much to learn from the RESYST project in this regard)!

Health systems Health Policy and Systems Research (HPSR)