Seye Abimbola and Aku Kwamie
From 3 to 7 February, two Emerging Voices had the privilege of being part of a meeting in the serene little town of Bellagio in northern Italy. We found ourselves among the winding streets steep with cobbled steps, lush gardens and grand villas overlooking Lake Como, surrounded by soaring snow-capped mountains which stretch from the Alps. When Russian writer Fyodor Dostoyevsky wrote in The Idiot (published in 1869), that “beauty will save the world”, he couldn’t have known that this declaration would find expression for two West Africans at the Rockefeller Foundation Bellagio Centre in 2014.
But how will beauty save the world? It seems, for the Rockefeller Foundation, it is about the power of beautiful surroundings to create the ambience within which to address some of the world’s most important problems. Since 1960, the residency and conference programme at the Rockefeller Foundation Bellagio Centre has offered scholars, artists, writers, scientists, policymakers and other professionals from around the world the opportunity to pursue and to share ideas, to debate and to collaborate. There’s something to be said for this understanding of Dostoyevsky’s idea of the link between beauty and global development.
Organised by the Health Governance Hub of the Public Health Foundation of India, and the Averting Maternal Death and Disability programme at the Columbia University Mailman School of Public Health, a three-day meeting was hosted at the Rockefeller Foundation Bellagio Centre to deliberate on the issue of posting and transfer of health workers and managers in low- and middle-income countries. The need to equitably and sustainably distribute the grossly insufficient volume of human resources for health across urban and rural settings makes posting and transfer an important issue. But beyond the challenge of supply, retention and distribution, posting and transfer could also be used as a tool to punish, to grant favour or reward political loyalty, or to get an incorruptible manager or administrator out of the way. We know that in settings where staff are over-worked, under-equipped, and little-supported, health workers understandably prefer to work in more comfortable locations, where they will have the opportunity to work with better equipment, progress in their careers, earn additional income (legitimately or not), and access good schools for their children and jobs for their spouse. We also know that inappropriate posting or transfer of health managers due to factors ranging from political concerns to poor prioritisation in the face of short supply, could compromise the quality of service delivery in health facilities or entire districts.
The negotiation spaces for posting and transfer are vast and range from advantages being gained from patronage networks and clientelism, to structural breakdowns in human resource management at different system levels. The layers of complexity seem endless. These processes are referred to as the ‘open secret’ of posting and transfer, and as one discussant noted: there are open secrets which are more open than secret, and there are open secrets which are more secret than open! The mere act of studying posting and transfer practices has the potential to enhance transparency. However, important as it is, this issue of posting and transfer has hitherto been poorly discussed, analysed and studied.
We joined a panel of researchers, decision-makers and policy advocates (19 of us from 12 countries) to find ways of defining the issue, framing it and putting it on the global health agenda. It was exciting to be on such a distinguished panel, and to have the sense that we were somehow, in a small way, contributing to making the operations of health systems more equitable, transparent, and legible by exploring the power relations that define posting and transfer practices.
It was equally important to be as warmly received as we were, and we commend the meeting organisers for actively tapping into the Emerging Voices network – we hope there will be more such opportunities for our growing cohort. In a sense, we felt like torch-bearers at the meeting, people who will carry on with the posting and transfer research and advocacy agenda down the line. We felt our role at the meeting was not only to contribute, but to learn and be prepared for this role. We think this is one reason why it is so important to continue including emerging researchers in such agenda-setting meetings. As Max Planck once said, a new idea does not triumph by convincing its opponents, but because a new generation grows up that is familiar with the idea. In this way, it is clear to us that emerging researchers need even more seats at even more tables.
We recognise that we were only representatives of other Emerging Voices at the meeting. And so, we would like this to be an opportunity to take the discussion further by asking you to share your own perspectives, experiences, and understandings, as well as your aspirations for a research and advocacy agenda on posting and transfer: what is necessary, what is feasible, what is utterly impossible? Let us continue to ‘open the secrets’ of posting and transfer. After all, the Akan proverb states: the one who climbs a good tree is the one who is helped.
Beauty will continue to save the world.
(For more information on posting and transfer, please read this background paper here (pdf)
Seye Abimbola is a researcher at the School of Public Health, University of Sydney, Australia and at the National Primary Health Care Development Agency, Abuja, Nigeria
Aku Kwamie is a researcher at the School of Public Health, University of Ghana, Accra, Ghana