Jean-Pierre Unger, Bart Criel, Guy Kegels (ITM)
Professor Pierre Mercenier’s contribution to the global reputation and impact of the Institute of Tropical Medicine and the Université Libre de Bruxelles (ULB) has been decisive. He has inspired an entire generation of students for the rest of their lives – doctors, nurses and health managers around the world. He also profoundly influenced the teachers and researchers of this Institute.
If we had to judge his work and legacy using the criteria that are now in vogue at universities, it is – as he often said himself – unlikely that he would have survived for a long time in academia: few articles, no impact factor, few ‘grants’ and a general refusal to engage in political or other strategic ‘networking’ to boost his case.
However, there are few scientific publications in the field of organization of health services that currently do not use one or more of the concepts he coined or that are marked by the ideas he developed together with his alter ego and longtime friend, Professor Harrie Van Balen: ‘ global ‘, ‘continuous ‘ and ‘ integrated ‘ care; the integrated health system, holistic nursing, community participation, co-management, teamwork; the integration of disease control program activities in primary health care systems; network management of local health systems …
If we embark on a bit of ‘knowledge archeology ‘, we find that most of these concepts were in fact first formulated in 1971, more specifically in a ‘limited edition’ magazine – a review of the work of the Study Group for the Reform of Medicine ) (Groupe d’Etude pour une Réforme de la Médecine or GERM). In this seminal document, entitled ‘Pour une politique de santé’, Pierre Mercenier and GERM colleagues presented the main elements of a coherent and emancipatory health policy. In 2014, this document remains valid. It is still used in public health teaching at this institute.
How can we explain then the extraordinary spread of Pierre Mercenier’s ideas over the past 40 years? Certainly, he capitalized on the times: with Halfdan Mahler (WHO) and Debabar Banerji in India, he helped formulate the policy of Primary Health Care that the UN would endorse at the Alma Ata conference in 1978.
But in addition to the – favourable – momentum at the time, he himself helped spread his concepts and ideas through an extraordinary ability for meaningful dialogue and listening, conceptual rigor, and a skill to get things done. This allowed him to have his ideas applied and integrated in a sustainable manner in health systems, a practice which required the inputs from many creative and motivated field practitioners.
The intrinsic quality of his theories on the organization of services and care systems also played a key role in their dissemination: they were useful for clinicians because he conceived them based on his own practice as a clinician – essentially that of a cardiologist and pneumologist. And indeed, Pierre Mercenier built throughout his career, in North and South, bridges between the clinical experience of health care providers and the one of health systems managers.
And it is by trying – relentlessly – to put his theories into practice that he has gradually managed to improve them. For this, he engaged in long-term monitoring of pilot areas such as Kasongo (DRC, formerly Zaire) , Dolisie ( Republic of Congo ) and Ayutthaya (Thailand); of national projects such as Thies (Senegal ); and of disease control programs ( such as tuberculosis in the province of Chaco , Argentina ) .
He was also a very independent thinker; this allowed him to come up, again and again, with useful concepts for public health professionals and society in general. He did not hesitate to harshly criticize dominant policies of the time or the Belgian health (non-)system, he was not afraid to get involved himself (for example, by establishing the GERM, mentioned above) and renounced alliances that could have been useful to him, if he felt it was necessary.
Paradoxically, it is likely that the evolution of health systems in recent decades has also contributed to the dissemination of some of his ideas. In order to contain the rising public expenditure for health care, governments were led to reinvent the delegation of tasks (‘ task shifting ‘), even in industrialized countries; the privatization of services also forced more than one public health specialist to examine the fragmentation and segmentation of systems and their implications for access to quality care. History can be cruel: as universities gradually adopted more of Pierre’s and Harrie’s ideas, the reality of health care in a big part of the world got further and further removed from the criteria they had formulated.
Beyond his concepts, of which it is difficult to predict sustainability, it is the attitude of Pierre in areas as diverse as action, education and research that we will never forget: his was the example of a humanist who refused to compromise, who knew how to work in a team and, throughout his life, using reflective thinking, put his concepts to the (often harsh) test in the field : starting from practice, and what is more, from a practice of changing services and health systems.