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Pakistan would do well to begin conversation on health

November 01, 2012


-Photo courtesy of WHO/Chem

Quite a mouthful and quite frankly not making much sense, the term health systems research (HSR), like the Millennium Development Goals (when forced down our throats many years back) was going through an identity crises and it seemed the global health advocates just could not draw enough attention towards it to make it more appetizing or palatable.

And yet today, there is a certain groundswell for this term and is becoming the new development mantra, within the health sector, and rightfully so.

It is time for Pakistan to step in and be counted among those who learnt from the successes and failures of others, before it may be too late. Too many babies and mothers are dying from deaths that can be prevented, too many poor are turning away from healthcare facilities that are there but which they cannot access.

Pakistan must join the global conversation on health systems research, before it’s too late.

This conversations between researchers, policymakers and practitioners from across the globe seem more relevant today and need to continue say experts if we are to save more than seven million children and newborns annually from dying unnecessarily from causes quite preventable. At the same time, we need to pay attention to the needs of an ageing population.

Judith Rodin of the Rockefellar Foundation says these “tragic outcomes” are a result of “dysfuncational and weak health systems” unable to treat those in most need. But these can be resolved if countries decide to learn from each others’ successes, compare models that were effectiveness at reducing costs and expanding coverage. She was talking at the opening of the Second Global Symposium on Health Systems Research being held in Beijing from October 31 to Nov 3 (the first was held at Montreux in 2010).

So what is HSR? It’s not biomedical research, or drug discovery, it’s not encoding the DNA or discovery of an organism either. And people who are experts in HSR are not always wearing white lab coats and peering at strange micro-organisms interpreting dishes through the microscope.

As Sir Mark Wolpert, director of the Wellcome Trust, UK, also one of the speakers at the opening, put it, it is “an intensely practical subject” that is trans-disciplinary and covered as wide a plethora of subjects from good health, economic and gender inequity to governance, accountability and political leadership etc.

Yet there was no one-size-fits-all model that could be used to overcome health issues, given cultural, economic and even geographic diversity. But to bring about good health, said Sir Mark, it was important to measure quality and associated health outcomes to hold health workers “accountable” which was only possible if HSR was in place.

The symposium, which brought over 1,800 participants from across the globe, also highlighted how countries overcame their health issues. Wherever the political leadership was committed to transforming health systems, change happened, pointed out experts.

Rodin gave a sprinkling of successful experiments that had or were transforming, or even saving the lives of ordinary people. What was interesting, it didn’t always cost a lot of money to bring about these little reforms; but maybe a little out of the box thinking did.

A half century back, there were just 40,000 trained doctors serving a population of 540 million. “For every doctor, there were 13,500 potential patients, suffering from cancer, painful joints and distended bellies,” said Rodin, adding that most of those doctors were in the cities while 80 per cent of the population lived in rural villages.

It was the barefoot doctors who brought about the change. While they prevented the spread of disease, she said, more importantly, they represented the spread of an idea: “the idea that every life has value, that everyone’s health matters, and that we have a responsibility to reach and care for people wherever they may be.”

Today, pointed out Rodin, “that idea has taken hold”.

China is placed among the four countries (others being India, Mexico and Thailand) commended globally by the World Health Organization for having adopted health reforms based on evidence and data.

So what did these four countries do right? They took the big bang approach of providing their population with universal access to subsidized healthcare. They not only established health policy and systems research institutions, build the capacity of experts in these set-ups, allocated more resources into research they also forged partnerships with the media to highlight health policy issues and began supporting  parliamentary standing committees in demanding policy-relevant knowledge. They also emphasised embedding research into decision-making.

But there are other countries that are striving towards universal health coverage (UHC) as well. Giving an example of Bangladesh, where health is a fundamental right but where 99 per cent of the population lacks coverage, Rodin talked about a pilot project recently launched in Chakaria, by BRAC, a non-governmental organisation. It was a health scheme where a prepaid package was developed costing just US$15 annually per household. By participating in that scheme, a family could seek medical consultation, hospitalisation, vaccination and maternal healthcare.

Rwanda, despite its dismal poverty score has managed to cover 90 per cent of its people also through an insurance scheme. Reports show that more and more people are opting to join the scheme. It has not only increased skilled births and prenatal visits. The 2010 demographic and health survey records show that Rwanda’s fertility rate dropped from six children per woman in 2005 to just four children.

So having built the momentum towards greater access, affordability, and equity across healthcare, the next step, the organisers aim to take on is to urge the United Nations to pass a resolution in the General Assembly on UHC. “This would act as a stepping-stone to embed universal health coverage firmly within the post-Millennium Development Goals framework,” said Rodin.


The author is a freelance journalist.