The Sophia Plan: A citizen-led proposal for a post-pandemic reset in Belgium

A blog by Elisabeth Paul and Mathieu Noirhomme

On Behalf of the Health Team of the Sophia Plan [1]

“Never waste a good crisis”, said Winston Churchill. It is in that spirit that the Resilience Management Group, made up of scientists and entrepreneurs of ecological transition, tried to transform the Covid-19 crisis in Belgium into an opportunity of resetting the economy on more sustainable, fair, and resilient grounds. The Group developed a draft plan of measures intended to help the authorities achieve this transition through adopting: the ‘Sophia’ plan, named after the Goddess of Wisdom. This plan adopts a systems approach as it recognizes the complex interrelations between the economic, social, environmental, climate, and health-related challenges the world is currently facing.

First came the publication of a first opinion paper setting the general principles proposed to emerge from the Covid-19 crisis and draw lessons to avoid new systemic crises of the same kind. Following this initial reflection, more people joined the Group which was then divided into 15 thematic sub-groups, each coordinated by a ‘trekker’, entitled with the task of developing concrete proposals for action. The Health Theme was coordinated by Mathieu Noirhomme and comprised a total of ten members from different backgrounds: academics, medical doctors, healthcare entrepreneurs, consultants, politicians, and international institution staff.

The Health Theme team shared the same values and adopted a ‘systems thinking for health system strengthening’ approach. It worked in a participative way – made possible through a number of conference calls and collective work on an interactive shared document since the lockdown prevented more cheerful face-to-face meetings. The team first developed a shared vision, aiming for ‘A holistic and integrated health policy that is person-centered and responsive to patients’ expectations, promotes participation of all, and reduces inequalities’. The vision relies on a general principle for action: ‘An ounce of prevention is worth a pound of cure’. Then, concrete priorities were brought out by combining the members’ various perspectives and experiences as family medicine practitioners, community health experts, health planners, policymakers, and patients. Some disagreements occurred but were solved through dialogue.

The Health group’s proposals for action are organized around four strategic orientations: (1) promoting an integrated health policy, instead of a number of disease management policies as currently observed in Belgium; (2) improving the balance of power between stakeholders through a collaborative health governance system; (3) valuing and rebalancing the status of healthcare personnel and caregivers; (4) augmenting the level of health financing and re-balancing resource allocations towards more valuable interventions, including health promotion and prevention, and reducing opportunities for corruption and conflicts of interest. A cornerstone of the proposal is to co-produce a public health strategy that is systemic, holistic, ethical, sustainable and integrated with the different governmental constituencies (as Belgium, a Federal State with roughly 11.5 million inhabitants, has no less than nine ministers in charge of health competencies, thus diluting responsibilities and resources), field actors and users of the health system, putting the individuals at the center of their own healthy life course and taking into account the social, environmental and local determinants of health.

The health sub-plan was shared with the other thematic groups to ensure coherence of the overall plan, and synergies between various themes. The ‘Sophia’ Plan was released through a press conference on May 14, 2020, and then disseminated through social media and thematic opinion pieces in the Belgian press. After the relaxing of sanitary measures, the Resilience Management Group contacted leaders of all major political parties to present the ‘Sophia’ Plan – with variable welcome, ranging from polite interest to frank disagreement.

On the context side, Belgium was, once more in its history, run by a transitional Federal government while waiting for creating a liveable political coalition. This process still took several months before reaching a conclusion. Finally, 493 days after the federal elections, a new elected government, comprising four political families, was officially appointed on September 30th, 2020. In the meantime, some thematic groups of the Resilience Management Group had started to develop a ‘Sophia 2’ Plan with more actionable and costed interventions. This was not the case of the Health Theme, as the group felt that the health policy environment was too unstable to develop a costed strategic plan without knowing if it would be welcome by the elected government.

At this stage, we are still convinced that the principles set forth by the ‘Sophia’ Plan are more than ever relevant, and even crucial, and that our participative approach gathering different perspectives and experiences was really enriching and brought out actionable strategies. However, its implementation is constrained by a number of governance issues. First, although most of us do belong to “storefront” public health institutions, we have not been acknowledged as a regular constituency that would give us political resonance. Moreover, all the members of the group have worked on a voluntary basis, with important time constraints worsened by the pandemic, preventing further work to be done after the launch of the ‘Sophia 1’ Plan. Second, our optimism has been tempered by the lack of buy-in of our proposals by political leaders. Many do not trust the mere possibility of strengthening the health system in Belgium – the absence of a national strategic plan to fight Covid-19, almost a year after the beginning of the pandemic, is indeed striking. Third, our government is still coping with the pandemic in an ‘emergency’ mode. It takes decisions on an ad-hoc basis, with a very short-term view, exclusively focused on Covid-19 – underestimating side-effects of its decision on other health issues – at the opposite of the systems view that however seems necessary. A Call for adopting public health fundamentals in managing the pandemic has been unheard, and so would probably be the ‘Sophia’ Plan which rests on a long-term, systemic, and holistic vision of health. Moreover, the Covid-19 management decision-making process totally lacks scientific debate and transparency, and is therefore at the opposite of the ‘inclusive policy dialogue’ approach advocated by the World Health Organization and the ‘Sophia’ Plan.

To conclude, we feel that the Covid-19 has made the need for a paradigm shift in health policymaking obvious. We have intended to set forth the basis of such a shift in Belgium, but it seems that the overall governance structure of our country is still not mature to make the big jump towards a really integrated health policy coupled with an actionable budgeted strategic plan with a results framework, deadlines and targets. Let’s hope that a global move in this direction will be initiated, so that decision-makers around the world understand that the ‘business-as-usual’ way of managing health systems and policies will not hold if we aim at “Building back better”.

[1] With thanks for their contributions to: Paul De Munck, Pierre Huygens, Muriel Gerkens, Jean-Louis Lamboray, Thomas Orban, Maye Vandenbussche.