10 Takeaways from Beijing: Second Global Symposium on Health Systems Research

10 Takeaways from Beijing: Second Global Symposium on Health Systems Research

Richard Horton moderates a panel on post-2015 development goals. {Photo credit: HSR-Symposium.org}Photo credit: HSR-Symposium.org

Last month, I joined over 1,800 participants from more than 100 countries in Beijing at the Second Global Symposium on Health Systems Research. We've made some concrete steps forward since we last met in Montreux, Switzerland, two years ago, among them the launch of a new research society Health Systems Global. Central topics of this year's discussions included: “Inclusion and Innovation towards Universal Health Coverage” (UHC), the symposium theme, and monitoring and evaluation.

Here are my top 10 takeaways from the symposium:

1. The global movement for universal health coverage is growing at an accelerating pace.

Led by pioneering countries such as Mexico, Thailand, and Ghana, and championed by visionary leaders such as the Rockefeller Foundation’s Judith Rodin, USAID’s Ariel Pablos-Mendez and Results for Development’s David de Ferranti, the concept of universal health coverage has developed into a global movement. Over 100 countries have taken steps towards UHC, of which more than 50 mostly high and middle income countries have achieved near UHC.

2. UHC should serve as the umbrella health goal for post-2015 Development Goals.

Lancet editor Richard Horton led a rousing panel on this topic, Post-2015 development goals: Framing the issues, prioritizing health and using the evidence, with speakers that included Joseph Kasonde, Minister of Health of Zambia; Anders Nordström, Ambassador for Global Health, Ministry for Foreign Affairs, Sweden; Bob Emrey from USAID; Toomas Palu, from the World Bank; and Heartfile president, Sania Nishtar. The World Health Organization (WHO) recently made a strong case  for a single umbrella health goal. As Horton implored: "Only one thing matters. Universal Health Coverage. Nothing else. Our path up the mountain to UHC will be steep. But we must not shirk our duty to get the world there."

3. Methodologies and metrics need to be strengthened: A common set of indicators for health systems and UHC are needed.

We need to define the health systems research field, taxonomies, and measures and collaborate across disciplines, including social and political sciences. Both qualitative and quantitative mixed-method approaches should be used. A mixed-method approach is needed so we can study both the hardware (building blocks of health systems) and software (ideas, interests, values, norms). As discussed by Dan Kraushaar and colleagues in a roundtable discussion paper, the Health Systems Global research society recently created in Beijing will provide the platform for advancing the health systems movement. The society will also contribute the development of appropriate indicators with methodologies that can help us better understand local health systems and measure UHC.

4. Access to medicines is vital for health impact, but this building block is often neglected in UHC policy and strategy.

Access to medicines is essential to achieving UHC health impact. Yet the challenge of ensuring access to medicines in UHC was largely missing from the conference, except for MSH’s pre-conference satellite on “Access to Medicines and UHC: Why Should we Care,” cohosted by Harvard Department of Population Medicine. Medicines consumes the largest share of household out-of-pocket spending in developing countries and failure to manage medicines benefits can rapidly threaten both the positive health impact and financial viability of UHC programs. In Ghana, for example, medicines spending went from 25% to 53% of the National Health Insurance Authority (NHIA) budget in a period of a few years.

5. Good governance and political will are prerequisites for UHC to work.

A plenary of representatives from the BRICS countries (Brazil, India, China, South Africa) articulated this argument persuasively. Good governance at all levels (national, institutional, community and facility) is the fundamental lever for achieving all other benefits of UHC, such as inclusiveness, effectiveness, efficiency and ultimately health impact. Governance plays the vital role of setting and realizing the vision for UHC, managing revenues and financing; ensuring equity in service delivery; and monitoring performance.

6. Equity is essential.

Jeanette Vega of the Rockefeller Foundation, Mickey Chopra of UNICEF, and Pablos-Mendez noted the strong need for equity and a human rights approach in all health systems and universal health coverage schemes. As Rodin argued in the opening plenary, “everyone’s life has value.” “Inclusion” toward UHC means recognizing the importance of right to health of all, especially the poorest and most vulnerable. Vast inequities exist in gender, economic, and education. Development groups will need to come up with innovative ways to include rights-based programming and partnering.

7. Citizens affected by inequities are demanding accountability.

Community-based monitoring in health, capacity building in knowledge translation, and holding health centers accountable by posting transparent health reports were some innovations reported on how civil society can help countries reach their UHC goals and demand equitable resource allocation. Walter Flores, Director, Centro de Estudios para la Equidad y Gobaranza en los Sistemas de Salud Guatemala gave some exciting examples of participatory research shaping the process toward UHC.

8. WHO is “Changing Mindsets” on health systems research and policy.

This new strategy released by the WHO makes the case for strong partnerships between researchers, implementers, and policymakers. Health systems research must be translated in a way that is pragmatic and useful for setting policy.

9. A multisectoral approach matters.

Sir Mark Walport of the Wellcome Trust, UK, made this point eloquently. Cross-sector collaborations will not only be critical toward achieving UHC, they will benefit from UHC. Health, education, labor, human rights, agriculture and economic sectors are all interdependent and all contribute to healthier nations.

10. Youth are key. We can’t plan for UHC without active involvement of youth who are its future.

Emerging Voices in research participated throughout the conference. We need to ensure programming for the growing number of children and youth aged 10-24 years who are increasingly unemployed, unable to access youth-friendly services, and have difficulty accessing sexual and reproductive health services.

Jonathan D. Quick, MD, MPH, is president and chief executive officer of Management Sciences for Health. Dr. Quick has worked in international health since 1978. He is a family physician and public health management specialist.

Did you attend the Health Systems Research Symposium in Beijing? What would you add to this list?
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