This blog is part of a series of blogs written by participants at HSR 2022 reflecting on some of the key messages and learnings emerging from the symposium.
Thanks to scholarship from the Health System Global, as an early-career researcher, I got lucky to be part of the 7th Global Symposium on Health System Research held in Bogota, Columbia between October 31 and November 4, 2022 (HSR2022). The theme of the HSR 2022 conference was “Health Systems Performance in the Political Agenda: Sharing Lessons for Current and Future Global Challenges” which I felt is a relevant one to better understand the health systems embedded within the increasingly polarized world. Yes! (right) politics is the glue that we need now to fix the health systems of the fractured world. Now more than ever! In this blog I share some random thoughts on the HSR 2022 conference.
Colombia is a country that has experienced so much pain historically with more than five decades of civil war triggered and sustained by various social, political, and economic factors. The warmth of the Columbian people and their aspiration for freedom, liberty, rights, equity, and justice was palpable (see the mind-boggling street art in Bogota that often portray political themes). It is in the air! Thus, the theme and location of the HSR 2022 conference were a perfect fit. While the conference provided a formal platform for learning, I learnt a big deal informally by exploring the Bogota city and interacting with people within and outside the conference venue. For instance, on my travel from hotel to the airport it was heartwarming to hear from a delegate that how Costa Rica, a small country had excellent digital health care navigation systems in place such as the edus where patients can easily know their rights and access social health security services, all in one place.
In all the sessions and plenaries that I attended social participation, community empowerment, sharing power and addressing justice concerns in health policy and systems research were recognized as needs for justice-oriented health system reforms. I learnt some interactive pedagogical approaches for conference sessions such as small group works embedded within larger sessions, live interview with panelists, doodling in the flipchart as you listen to the sessions, podcasts bytes and testimonies from field level actors). The visit was also an opportunity to learn about Colombian country, how despite its history wrenching in pain with armed conflicts, was able to achieve a relatively better access to health care services for its people when compared to my own country India (Out of pocket expenditure for health is more than 70%). Furthermore, the two HSG thematic working group meetings (SHAPES and private health sector) were particularly interesting to me for two reasons. i) The SHAPES thematic working group emphasized importance of using historical lens for understanding health system issues ii) The private health sector thematic working group deliberated on the priority research areas on private health sector. Some members indicated the need for innovative models of engagement with the private health sector for regulation and service delivery that is ethically grounded. One other member emphasized the need for the clear and clever use of evidence to engage with private health sector. To the list I added the importance of identifying ways to nurture value-based and ethically grounded private health sector. I also noticed the deliberations (at least the ones I attended) missed some of the critical factors for health system reforms and the shrewd audience had to bring the following issues to the attention of the panelists.
- What is the role of medical power in health policy reforms?
The sessions on community empowerment/ participatory action research, justice in global health research and policy engagement and even the three plenaries I attended hardly covered the role of medical power in health system reforms. Evidence shows that the dominance of medical fraternity (especially from the allopathic system of medicine and their professional associations in health policy processes in national health systems. To what extent the medical power is accommodative to ideas like external regulation and social participation in health policy processes could have been critically examined.
- Where is participatory action research at higher levels?
Engagement and co-creation with communities was recognized as an essential approach in health research to redress epistemic injustice and to decolonise health sciences. Participatory action research (PAR) is a widely acclaimed methodology in health system research and obviously quite some sessions on social participation in the HSR conference deliberated on the projects that employed PAR. Most often than not PAR is confined to micro level and marginalized communities. PAR projects at meso and macrolevel are few and far. This demands critical reflection on part of the researchers to conduct PAR at higher levels and with actors powerful than the researchers themselves.
- How inclusive was the HSR conference?
While diversity, inclusivity and equity were the slogans of HSR for justice-oriented health systems, the composition of delegates in the HSR conference was mainly skewed towards researchers. Community representatives, private health sector actors and policy makers were a minority. Events like HSR is a good platform to bring diverse stakeholders and enable dialogues on issues that matter to strengthening national health systems. Such a multi-stakeholder dialogue is a step towards enhancing trust, discussion and collective problem solving.
HSR 2022 was my first in-person conference after the COVID-19 pandemic. So it was an uplifting experience personally and professionally to travel to other part of the world, meet people and network. The next HSR conference will be at Nagasaki, Japan in 2024. I sincerely hope that the Japan version of HSR will be equally exciting but much more inclusive and critical in its deliberations.
By Meena Putturaj
(Meena Putturaj is an early career researcher who is currently pursuing a PhD in public health and is based in India)