Goran Zangana, Health systems academic and activist, Iraq

"We need to address issues relating to the wider political and cultural contexts. This is what will make the difference."

Goran Zangana is reflective about his experiences of trying to improve health policy in his home country of Iraq. Since his youth, his interest in politics and pushing for progressive change has on occasion got him into trouble, and once he ended up in court, but this has never stopped him from striving for a better health system for his country. 

He recently completed a PhD at Edinburgh University, UK in health policy (of course!) focusing on the conflict-affected setting of Iraq. But as a medical doctor, what made him want to look at health policy in the first place?

“At the beginning, something excited me about health systems and health policy. One of the reasons is that I am interested in politics in general. This is not something strange for people from the Middle East and Iraq and Kurdistan. There is an immediate effect of politics, and you can see it everywhere. It’s not only in conflict-affected areas but throughout every aspect of life in this region.”

Goran has faced this power in real life, almost by accident. Being taken to court for having confronted power institutions in a little-known magazine.

Fortunately, Goran won the case, but he considers the experience to be formative in his understandings of the realities of governance in health systems.

“The reason I am interested in governance is related to my personal experience with politics, the notion of power in politics in general and also in health systems. Part of why health systems do not work, particularly in the Eastern Mediterranean Region is not the lack of technical tools to advance health systems governance. We need to address issues relating to the wider political and cultural contexts. This is what will make the difference.”

Goran takes this understanding seriously and is engaged with like-minded colleagues in Iraq to tackle some of the real issues facing the health system.

“I am now involved in the Kurdish region, with a number of NGOs, academics and policymakers. After I, along with other colleagues, started challenging some of the establishment and power nucleases in the health system, the immediate reaction was to isolate us and try to make us unheard. Despite the fact that there are attempts to stop our participation, there are still ways we have found to stay involved. We are working with Members of Parliament in the Kurdish Region and nationally to formulate health policy bills, and formulate questions that are posed to the Minister of Health.”

Goran sees that governance and power are at the heart of change in health systems. Having recently attended the opening of the Eastern Mediterranean Regional chapter for the Health Systems Governance Collaborative, what does he think about the group’s endeavours?

“The Collaborative is a great initiative, it’s amazing to start talking about this concept. The meeting was informative and Ministries of Health, and academics from the region presented their experiences and research findings.” 

But Goran also had a word of caution about how we approach this area of work.

“What I noticed is that we were talking mostly about positive experiences, which is great, and we should learn from these experiences. But I think the reason why there is a focus on positive experience is that most people represented formal institutions. These institutions did not tend to talk about the less positive things, that are not discussed much. The idea of freedom of expression, human rights and patients rights are not usually talked about in governance discussions.”

“Some people ironically try to present governance as apolitical and not related to politics, but this is just an excuse to oppress dissent, and opposition to other views. For example, in the Eastern Mediterranean Region there are examples of academics and journalists being harassed, jailed and sometimes even assassinated because of their research and views. This is something that in the Collaborative we should highlight and try to create safe space for activists and academics and other individuals who are voicing criticism and different views.”

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