Webinar - Towards Adaptive Complex Health Systems: What, How, Now!
Many countries have realized that fighting pandemics such as Covid-19 has come at a price which few can afford. The pandemic has painfully foregrounded the many dimensions of our health and governance systems that are dysfunctional. It has exposed how large groups of people are neglected or not well served. But moving to complex, dynamic and much more adaptive systems governance does not happen automatically.
In this fifth webinar in a series hosted by the Global Health Governance: Building the Reset campaign, we will explore the crucial question of what forms of adaptivity in health systems are needed so that these systems work for all and what needs to change now in concrete terms so as to grow a more adaptive health environment? We will look for positive entry points in current post-Covid-19 strategizing to enhance adaptivity in health systems and will foreground constructive actionable ideas from different arenas of dynamic complex systems thought,policy and practice.
This fifth Building the Reset webinar explored the urgent topic of our health systems adaptivity and readiness for the future.
Prof. Manuel M. Dayritkicked off by stressing the crucial importance of acknowledging the flaws in the systems, and seize this moment to do a reset. He argued now to be the time for governments and societies to actively seek stronger collective awareness, develop a far more integrated vision on health, rally around collective efforts to build forward better, and come up with more inclusive ways to communicate with all concerned. While he emphasized how many people had worked around the clock to deal with the current pandemic, prof. Dayrit urged to face up to the many realities of ill-adaptation which had emerged during the pandemic and the persistent forms of resistance and siloed performance in health which hamper progress. He stressed that fostering greater social cohesion was vital, in communities, national societies and around the globe. He made a plea for moving beyond the mere rhetoric of ‘whole-of-society responses’ to move to concrete mechanisms of change, such as investing in governance capacities in the system, starting decentrally, with local governments.
Dr. Jean-Benoît Falisse spoke from his current work as lead researcher of the Covid-19 Response Governance Mapping Initiative (http://www.covid19-governance.sps.ed.ac.uk/). This comparativecollaborationis in the process of documenting the ways in which Covid-19 responses have been organised around the world. The research so far has focused on experiences from 20 countries. In order to unpack the notion of ‘adaptivity’ of health systems further, Jean-Benoit Falisse flagged three recent observations as questions for feedback. He first remarked that in a number of places ‘adaptivity’ at the top of the governance system during Covid-19 appeared to have amount to a governance ‘take-over’, with task forces composed of non-health actors, or with for instance ministries of economy or defense assuming the governance lead in the pandemic response. In addition, he shared the observation that some subsystems in health, which prior to the Covid-19 outbreak had been supporting the mainstreaming of specific development concerns (such as for example gender) had come apart under the pressures of the pandemic. Given the ease with which these concerns appeared sidelined in some places, it begged the question of how resilient such prior mainstreaming efforts had been to begin with? Thirdly, the study data seemed to indicate that in many countries non-state actors had not come in very strongly. Private-sector and civil-society organizations seemed mainly coopted during the crisis in the role of ‘service providers’, diminishing the much wider spectrum of non-states roles which were under development prior to Covid-19. What did such turns of action under Covid-19 tell us about the health system’s adaptive potentials?
Dr. Prashanth N Srinivas spoke from his broad interest in studying social determinants of health and tackling health inequities in indigenous communities in India. He added four additional key considerations to the conversation, all focused on pushing future conversations on health system adaptivity more in the direction of people’s health and local-level considerations within the system. An adaptive health system of the future, he argued, should pay much more focused attention to diversity and the heterogeneity of people’s experiences at micro-levels in health. Similarly, more critical attention should be given to ‘uncertainties’, the existing hierarchies of ‘knowledge’ and knowledge ‘dictums’, and the often ambiguous roles of ‘experts’. Adaptive systems of the future should hold more work more in ‘co-construction’. It should operate with more critical sensitivity to the use of specific languages surrounding crises, such as for instance regarding the military metaphors so current in the Covid-19 pandemic today. In general, far deeper reflection could be attempted on how to do justice to the real complexities of health in our time and age, with multiple stakeholders, a wide range of very divergent interests and strong power-dynamics.
Prof. Dr. Maha El Rabbat concluded the series of introductory reflections, by stressing the political window of opportunity for foregrounding ‘health and wellbeing’ together, as inextricably linked. Both concerns had finally come center-stage in many countries. And the need to invest in new public health policies and arrangements had become a strong and urgent call in most governance circles. This historical momentum should be now captured and used to move beyond the mere rhetoric of all-of-government and all-of-society goodwill expressions to the development of concrete governance methods, new more inclusive institutions and practical synergies which had long been called for. Strong and sustained commitment to such agendas was now of the essence.
The animated discussions that followed further explored how to bring about the necessary shifts of focus suggested by the speakers to enhance health systems adaptivity. Several participants commented on the concrete steps this would demand and the ways to keep visible what had previously been ignored or left unnoticed. Most participants agreed that rebuilding social cohesion and trust and fostering greater policy integration were crucial ingredients of any future governance reset, which would probably best be started at the local level.
At the same time, a number of critical references were made to the equal relevance of such transformations in the far less transparent global governance processes which today still heavily impact the national and subnational health governance spaces, processes over which few feel they have any serious control. This topic will be explored further in one of the next webinars in our Building the Reset series, on new multilateralism.
Prof. Manuel M. Dayrit
Manuel M. Dayrit, MD, MSc, is recognized as one of the Philippines’ leading epidemiologists. He was Secretary of Health (Minister) from 2001-2005 when he led the Department of Health in the suppression of SARS in 2003. He is currently active in COVID-19 control efforts and leads a public-private task force to undertake seroprevalence surveys in local communities.
From 2005 to 2012, Dr. Dayrit was Director of the Department of Human Resources for Health at the World Health Organization in Geneva. From 2013 to 2019, he was Dean of the Ateneo School of Medicine and Public Health. Today he is Adjunct Professor at Ateneo.
Dr. Dayrit has degrees from the Ateneo de Manila University, the University of the Philippines College of Medicine, and the London School of Hygiene and Tropical Medicine. He also trained at the US Centers for Disease Control and Prevention.
Dr. Jean-Benoît Falisse
Jean-Benoît Falisse is a lecturer at the Centre of African Studies and a fellow at the Edinburgh Futures Institute, both at the University of Edinburgh. He has been working on health governance and social accountability in health since 2009, both for NGOs and international organisations and as an academic researcher. His work has included mixed-methods and interdisciplinary research on health financing, health facility committees, and the 'indigent' label, all in the African Great Lakes region (DR Congo, Burundi). Jean-Benoît's approach spans across social science disciplines, reflecting his academic background in development economics, history, political sciences, and philosophy. He is the lead researcher and initiator of the Covid-19 Response Governance Mapping Initiative (http://www.covid19-governance.sps.ed.ac.uk/), a collaborative project that documents the ways in which the Covid-19 response is decided and organised around the world.
Prashanth N Srinivas
Prashant N Srinivas (1979, Karnataka, India) is a medical doctor with experience in working in primary care in southern India. He obtained a Master in Public Health from ITM, Antwerp (HSMP 2007-08) and subsequently a PhD in public health (via ITM) from Universite Catholique de Louvain. He leads the Health Equity Cluster (team) at the Institute of Public Health, Bengaluru (India) with broad interests in studying social determinants of health and health inequities across various axes of inequities in India. Since 2014, he lives and works at a public health research field station in BRT Tiger Reserve in southern India. Through a fellowship from the DBT/Wellcome Trust India Alliance, he has set up collaborations to examine health inequities in indigenous communities in multiple remote forested locations in southern, central and northeast India. He has experience with using health policy and systems research methods particularly realist evaluation, implementation research and participatory action research approaches in addition to experience with quantitative epidemiological methods. He is part of research consortia on health systems strengthening for OneHealth and mental health in primary health care. He is active in promoting a southern/LMIC-led leadership in global health research.
Prof. Dr. Maha El Rabbat
Professor Dr. Maha El Rabbat is a former Minister of Health and Population of Egypt, Executive Director of the Middle East and North Africa Health Policy Forum and Professor of Public Health at Cairo University. She has been appointed as special envoy to director-general of the WHO on COVID-19 for EMR. She has held several high-level political, academic and leadership positions and has accumulated more than 30 years of strategic leadership, policy, advocacy and operational expertise. She has also worked closely with national, regional, and international organizations as a public health expert on a wide range of public health issues and priorities in various contexts, such as deprived areas and among vulnerable groups. She has built a strong understanding of the global variations and transformational health needs of the region and of the existing vulnerabilities, challenges and opportunities for promoting health, preventing disease, building emergency preparedness and sustaining results. Through her work, she seeks to strengthen health systems and human development in countries in the region particularly in middle- and lower-income countries through evidence-based policy, knowledge exchange and networking.