Beverly Ho (EVs 2012), with some inputs from other EVs
Between 13-16 December 2013, some of us, Emerging Voices from the 2010 and/or 2012 EV venture, attended the second Health Systems in Asia conference in Singapore as oral and/or poster presenters. As is well known, the global health community has been quite successful in putting forward the UHC agenda at the forefront of issues in many countries. And indeed, many countries have begun their (sometimes painful) acceleration towards UHC. Asian countries are no exception.
The conference’s many plenary and parallel sessions highlighted key themes/issues which we outline below. Evidence to guide countries exists for some of these; but definitely not a lot. Thus, in the spirit of the season, we identified a potential ‘evidence’ wish list for countries facing the herculean task of UHC.
– Managing Pluralism. Tim Evans’ plenary lecture on pluralistic health systems emphasized the inevitability of this feature as countries navigate the path towards UHC. A key challenge here is balancing a participatory approach with rigour and efficiency, lest you end up overconsulting. Throughout the conference, country after country showed that they are grappling with finding the appropriate governance structure, regulatory mechanisms and sustainable capacity to manage pluralistic systems. By ‘sustainable capacity’ we refer here to management capacity – both for inter and intra-organizational issues – which is so often overlooked.
– Service Delivery as key to UHC. Toomas Palu pointed out that the breadth part of UHC is very much hyped, when the core of UHC is really delivering the most appropriate health-related services to the right person at the right time at a cost that will not lead to impoverishment. But can countries really accelerate towards UHC even with a rudimentary service delivery network or wanting health infrastructure? If so, how fast can this happen? Is there a need to reinvent our systems so that we don’t simply make more of the same health facilities or scale up HRH production like what is currently being done just because we’re catching up! What system innovations are there to scale up service delivery? We need bold ideas; we need to transform the way service is delivered. Related to this is another issue that Tim Evans raised – that perhaps tracking OOP may not be as important as impoverishment and catastrophic spending.
– Ensuring Access to Medicines. Maryam Bigdeli actively described the issues surrounding access to medicines in her (many) tweets. Admittedly, addressing medicine access is one of the most underrated or overlooked supply side interventions.In the context of the NCD epidemic, we certainly need to expand access to medicines and keep the pharmacists well-represented in health system debates. And NCDs are just one example, there are many other issues for which you can make the same case.
Indeed, so much more needs to be done. This holiday season, we are reminded of the importance of giving. Ideally, we shouldn’t only give during this festive season but throughout the year. And as we in the research community are expected to “give” evidence, may we ensure that what we offer is not only technically sound but also practical, socially relevant and truly responsive to our consumers’ needs.