The Science and Practice of People-Centred Health Systems

A report from the 3rd Global Symposium on Health Systems Research

by Luisa Pettigrew - WONCA WHO Liaison person

The Third Global Symposium on Health Systems Research took place in Cape Town during the first week of October. The event was hosted by the Health Systems Global and co-sponsored by the World Health Organization (WHO), Alliance for Health Policy and Systems Research as well as various national and international health related institutions. The symposium aims to bring people together to work towards delivering more evidence-based policy making in health, with a focus principally on low and middle income countries.

The theme of this year’s event was the Science and Practice of People-Centred Health Systems. Close to 2000 participants from across the globe took part. These included policy-makers, activists, community representatives, managers, researchers and educators. Many were from universities, non-governmental organisations, ministries of health and in particular from the WHO and World Bank.

Satellite sessions with key relevance to primary care included a workshop on the World Bank's and Bill and Melinda Gates Foundation's new Primary Health Care Performance Initiative; a project aiming to understand, as they described, 'the black box' of primary care processes through the development of universal indicators (see photo - World Bank's and Bill & Melinda Gates Foundation's Primary Health Care Performance Initiative satellite session).

Stakeholder consultation also took place during the symposium's satellite sessions on the first draft of eight thematic working groups' papers which will inform the upcoming Global Strategy on Human Resources for Health. Online public consultation on this continues until 24th November 2014, therefore please take a look and respond as an individual or on behalf of your family medicine organisation. This document is likely to be highly relevant for primary care and family medicine worldwide over the coming years.

Plenary discussions during the symposium raised challenging questions such as: What facets of people-centred health systems strengthen accountability for improved quality of care? What role do health professionals play in promoting people-centred health systems? What are the challenges in initiating, doing, disseminating and funding health systems research for people-centred health systems? Presentations and workshops covered subjects including: How to engage individuals, families, communities and service providers in health-sector decision making; Health worker motivation; Strategies for improving the quality of primary care; Research methods in complex health systems; Health systems financing and how to achieve universal health coverage.

So what does a ‘People-Centred’ health system look like? On the ground it seemed complex, many participants were not quite sure and views were not always consistent. Was it a reframing of the declaration of Alma Ata, or a reiteration of the 2008 World Health Report on Primary Health Care? To some degree it seems it is. Therefore could this result in another case of policy aiming to strengthen primary health care lost in translation for many? Hopefully not.

The upcoming WHO strategy on Person-Centred Integrated Health Services presents five strategic directions which include concrete examples of what 'people-centred integrated' health services should look like. This includes a much greater role for civil society and local communities in shaping health systems and health services. Amongst other areas it also includes strengthening the gatekeeping role of primary care and improving the prestige of family doctors (see photo - WHO's Person-Centred Integrated Health Services strategy session, 'Strategic Direction 3'.).

Yet, although during the symposium there was some recognition of the challenges many countries face to train and retain high quality family doctors, discussions on human resources focused largely on scaling up the role of community health workers and ‘mid-level’ workers (midwives, nurses and health workers somewhere between these and a doctor). It could be argued rightly so as mid-level workers play a vital role in the delivery of primary care and the capacity of many countries worldwide to invest in a workforce of family doctors is still limited. However there are many good examples where countries have and continue to successfully invest in family medicine [1]. Moreover the evidence of a strategy focusing solely on mid-level workers, in particular without proper supervision or training, to delivery to high quality comprehensive deliver primary is poor [2]. In the long run aiming for a family doctor, for every multidisciplinary primary care team, for every person in the world seems the most likely way to achieve the delivery of equitable, high quality, comprehensive, coordinated, continuous people-centred primary care. Unfortunately discussions on how to achieve this long-term goal seemed faint at the symposium.

So how can family doctors help contribute towards the Science and Practice of People-Centred Health Systems? Family medicine by its very nature aims to deliver patient and person centred care [3]. Delivering people-centred primary care involves also taking a population based approach with a focus on prevention, multi-sectorial collaboration and vitally on active community participation. Many family doctors and their multidisciplinary primary care teams already do this. However notably there were few family doctors at the symposium. A number of factors, not least clinical commitments, are likely to have contributed to this. However it is also a reflection of the limited opportunities that exist for family doctors globally to formally develop expertise in research and policy-making in order to participate in these.

The closing Cape Town statement from the Third Global Symposium on Health Systems Research highlighted the need to continue to strengthen efforts to nurture the future generations of the health systems community. In order to strengthen primary care to support integrated and people-centred health systems, this must include investment in a future generation of family doctors from across the world that can bridge and help shape the three, often disparate, worlds of front-line service delivery, academia and policymaking.

To respond to the online public consultation on the post 2015 Global Strategy on Human Resources for Health, before 24th November 2014 click here.

Webcasts and reports from the symposium are available online.

Special Editions of Health Policy and Planning: The Science and Practice of People-Centred Health Systems and PLOS One: Monitoring Universal Health Coverage are freely available through online open access.

references
1. Kidd, M. (ed), The Contribution of Family Medicine to Improving Health Systems: A guidebook from the World Organization of Family Doctors (2nd Edition).
2. Lassi, Z.S., et al., Quality of care provided by mid-level health workers: systematic review and meta-analysis. Bulletin of the World Health Organization, 2013. 91(11): p. 824-833I.
3. Starfield, B., Is patient-centered care the same as person-focused care? Perm J, 2011. 15(2): p. 63-9.