New health discoveries are often not immediately accessible or affordable to the average individual, particularly in low and middle-income countries.
When we think of health innovations, we are often drawn to images of scientists in laboratories making ground-breaking discoveries – inventing state-of-the-art equipment using a highly sophisticated computerised system, or formulating a revolutionary new drug or treatment.
While the publicity and hope that are normally associated with these types of breakthroughs are understandable, the reality is that new health discoveries are often not immediately accessible or affordable to the average individual, particularly in low and middle-income countries. Poorer populations are generally the last to get access to them.
The ability to improve the health of individuals depends on much more than new discoveries or having the tools or the medications to diagnose or treat a disease. Rather, it rests on the ability of the health system to absorb and roll-out new technologies through existing services, with minimal disruption and maximum effect.
Advances in medical interventions will mean very little and have little effect on the burden of disease unless there exists a strong health system through which programmes can be rolled out as widely as possible into communities.
Addressing the health needs of socially disadvantaged groups demands a strong health system. Even the important, simple innovations made possible by new mHealth technology, such as the recently launched MomConnect app, that provides expectant mothers with information about their pregnancy, will only be effective if the health system through which they work performs well.
All successful health innovations depend on the capability of health systems to devise appropriate policy guidelines, to develop appropriate health programmes, to motivate health care workers, as well as to provide relevant training to them, and to deliver responsive and acceptable health care to individuals and communities.
Responsive health systems also engage with patients and communities, empowering them to hold those in positions of authority to account for what they do and how they do it. It is in this context then, that research into health policy and systems – how they work, how to strengthen them – becomes relevant.
Health systems are made up of a set of interconnected activities that develop over time and reflect local circumstances. They are driven by people of different experiences whose objectives are ultimately focused on improving the health of all people and ensuring social equity. The World Health Organisation (WHO) has identified six key building blocks within every health system.
These include governance, information, financing, service delivery, human resources, medicines and technologies. The WHO also points out that it is imperative to see that the health system “like any other system, is a set of interconnected parts that must function together to be effective. Changes in one area have repercussions for elsewhere. Improvements in one area cannot be achieved without contributions from others. Interaction between building blocks is essential for achieving better health outcomes”.
But health systems are ultimately powered by people and driven by their relationships. As in all other aspects of life, human interactions are challenging and unpredictable and need constant care. A major factor in health system dysfunction is weak interaction between people and activities, resulting in people working parallel but oblivious to each other. Reported drug stock-outs in our public health system are one example of such a health system breakdown.
Far from functioning as a huge machine-like structure, health systems are a dynamic human system with immense potential for innovation and creativity. These qualities are essential in being responsive to the huge array of different health needs and challenges that confront every system at an individual and population level. Understanding, defining and connecting people and activities within such systems is not an easy task, but is supported through Health Policy and Systems Research (HPSR).
Blending expertise in economics, sociology, anthropology, political science, public health and epidemiology, this interdisciplinary form of research explores the complex relationships and forces between people within health systems. It informs health policy. It promotes real health systems transformation.
SA health system
There is consensus that South Africa is unlikely to achieve the targets set out in the Millennium Development Goals as we are still attempting to address these issues within the context of a fragile and overburdened health system, and the inequity spawned by apartheid.
How can South Africa redress the imbalances of the past and expand health care to the entire population despite the continuing challenges? How can the vital pockets of creativity within this system be nurtured, and innovations in care, management, human interactions, accountability and more, be spread across the country?
The post-2015 development agenda will focus on universal health coverage and attention will be directed towards eradicating disparities in access to health care based on social or economic circumstances. The plans to implement National Health Insurance (NHI), drawing on lessons and ideas from countries including Thailand, Brazil and those, such as the UK, with a longer history of health reform experience, represent the South African Government’s commitment to bring health care to all its citizens.
Implementing such a strategy will have huge human, financial, administrative and infrastructural implications, and demands strong relationships and interconnections among people and activities.
Health policy and systems research has played a key role in informing decisions and planning for the implementation of the NHI. The body of research evidence generated inside and outside South Africa is immense and provides valuable information on a number of critical areas, and not just on the matter of financing.
Local researchers have not only documented the common challenges in implementing health policies, but have also highlighted the opportunities for strengthening health systems through, for example, different approaches to linking funding to service provision, the rollout and scale-up of community health workers, the decentralisation of management functions to district health authorities and engaging patient and citizens in health decision-making. These are just a handful of the examples of the HPSR knowledge produced in South Africa.
Third Global Symposium
This month, South Africa will host the prestigious Third Global Symposium on Health Systems Research to share and apply cutting-edge research to strengthen health systems.
Under the theme of the Science and Practice of People-centred Health Systems, the Symposium is an opportunity to work towards the vision of globally connected health systems “that contribute to the attainment of better health, equity and well-being”. The South African experience will be well represented in the programme.
For example one session will discuss the Office of Health Standards’ Compliance, a newly formed entity that will monitor the quality of health care delivery in South Africa.
So, how can we ensure the cycle of innovations needed to support health system strengthening well into the future?
This is the role of health policy and systems research, as it provides the evidence needed to support decision-making across the health system. Although South Africa is internationally renowned for its health economics and health policy and systems research outputs, it is important to strengthen national recognition of its contribution to population health.
Despite recent investment in the field by the National Research Foundation, more and sustained funding streams must be channeled to related research and capacity development, to attract and retain young researchers in the field.
If we are to grow HPSR capacity for the future, and embed it within our health system, it is also imperative that we establish strong relationships among researchers, health managers, civil society and citizen groups, and policy-makers.
Building these networks will allow discovery and dissemination of innovation within the system, providing the opportunities for our future HSPR researchers to influence change in health systems and ultimately, to improve the health of our communities.
Professor Lucy Gilson is head of the Health Policy and Systems Division at the University of Cape Town. She is also the co-chairperson of the South African Local Organising Consortium (a collaboration between the University of Cape Town, University of the Western Cape, Health Systems Trust, Stellenbosch University and the South African Medical Research Council) which is coordinating the Third Global Symposium on Health Systems Research taking place in Cape Town from September 29 to October 3 2014.