The Wits School of Public Health (WSPH) has moved to a magnificent new building across the road from the Wits Health Sciences Faculty in Parktown, Johannesburg. To celebrate the event, the School hosted an international public health symposium on 24 January 2013, entitled ‘Building Capacity 4 Health’.
This theme acknowledged the importance of public health in achieving good health for all. It also embraced the purpose of the School’s new home: a place for teaching and promotion of learning, knowledge generation and dissemination, and public health leadership and advocacy.
Close to 400 delegates, including public and private health practitioners, policy experts from government, representatives from non-governmental organisations, universities, the media, and international delegates from across Africa, Europe, Asia and North America attended this inaugural event.
Professor Laetitia Rispel, the head of the School of Public Health, explained that the four symposium sessions or sub-themes captured different aspects of building capacity 4 health, while highlighting the scholarly activities of the Wits School of Public Health (WSPH). The first session focused on research as a tool to improve health. In addition to providing an international perspective on how research makes a difference to health policy development and/or to the communities or populations with whom the research is done, this session highlighted the comparative strengths of the WSPH in demographic and population health surveillance and in occupational health research. The second session of the symposium put the spotlight on the linkages between research, policy, practice and implementation. Drawing primarily on research done in the WSPH, the session highlighted the value of independent, high quality and relevant research, collaborative networks, policy advocacy, and active engagement with government and with civil society. The third session focused on building the next generation of public health leaders. The goal of this session was to share teaching innovations at the WSPH, ranging from new tracks in the Master of Public Health programme, our strengths in measurement sciences and public health medicine training through to our African wide PhD programme that aims to build a vibrant African academy. The final session recognised the critical imperative to improve the effectiveness and efficiency of the health system. The presentations interrogated the implementation of the national health insurance system in South Africa and drew attention to the importance of addressing fraud and corruption in the health sector.
In his welcome address, Wits Vice-Chancellor Professor Loyiso Nongxa, said:
“I am proud that the building is located in the City of Johannesburg, a world class city with a world class university. The opening of the new School of Public Health Building reiterates that universities are important, and we need to keep saying that to ourselves, to government, to other sectors and to everyone. Public health matters. This new building will enable us to pursue academic excellence and equity, as we have shown here at Wits.”
Chief Director of Non-Communicable Diseases in the Department of Health, Mr Melvin Freeman, was delegated by the Minister of Health, Dr Aaron Motsoaledi, to read his opening keynote address. The Minister drew from his own experience as a medical student where the worst offices were occupied by public health medicine specialists. The Minister noted that the new building is a reflection that investors and donors realise the importance of public health.
“It is exciting that the new building is a green building. The same idea needs to be taken to South Africa’s hospitals and clinics.”
The Minister’s speech emphasised the importance of building capacity in human resources for health in order to improve efficiency in the health system and to achieve the Millennium Development Goals.
“Health system posts need to be filled by skilled and competent people according to the Negotiated Service Delivery Agreement.”
He expressed hope that the new building would enable the production of more health professionals for South Africa. To fulfil this, he urged everyone to work together to overhaul a largely curative, expensive and unsustainable health system and move towards a preventive one based on Alma Ata principles and universal access to health.
The first session highlighted the value of research in bringing about social and population health improvements. The first speaker was Dr Alex Ezeh from the African Population Health Research Centre (APHRC) in Kenya who directs the Consortium for Advanced Research Training in Africa (CARTA) and is an honorary professor at the School of Public Health. He stressed the need to create, nurture and sustain quality research in Africa given the massive difficulties faced by countries on the continent regarding lack of capacity, leadership and funding for research and development. He challenged South Africa to take up the responsibility of supporting research in the rest of Africa.
The second speaker, Professor Jill Murray from the National Institute of Occupational Health and the Wits School of Public Health, highlighted the impact research has had in improving the health of South African mineworkers by informing policy and legislative reforms. However, a gap still exists between policy and implementation.
“We can make a difference, but it’s a marathon, not a sprint,” she concluded.
The closing speakers of this session, Professors Steve Tollman and Kathleen Kahn, reflected on the substantive body of work related to Agincourt and, in so doing, demonstrated how population-based research that responds effectively to prevailing problems contributes critical intelligence to health and social development both locally and internationally.
In summary, research has to be timely and responsive to local needs. It must engage with different relevant stakeholders and provide solutions rather than just simply identify problems.
Picking up on where the previous session left off, Professor Karen Hofman demonstrated how research can influence policy in a presentation on a high-impact, cost-effective population-based salt reduction strategy. She emphasized the importance of allowing policy-makers to inform research agendas, even before research begins, and engaging with them throughout the research process. She also encouraged researchers to “get over your fear of industry and the media” as they are key to implementing policies. Policy makers were urged to take the time to educate academics about their needs.
“We can replicate the approach we used for salt for other interventions to avert premature deaths and save money and livelihoods.”
In a lively exchange, discussant Dr. Yussuf Saloojee, Director of the National Council Against Smoking, argued that industry always places profits before people and should not influence policy. He highlighted the “magnificent example” of Thai Health, which uses alcohol and tobacco levies to fund health promotion. He urged that this model could be used to create a Health Promotion Foundation in South Africa.
In an intriguingly titled presentation “Are we actually doing what we think we are doing?” Dr. Azwi Takalani presented operational research aimed at improving the quality of monthly morbidity and mortality meetings in a hospital. She showed that National Care Standards were not being implemented as intended; often there was no follow up on actions that needed to be implemented to improve quality of care. And while the researchers identified a number of recommendations, they were unable to persuade departments to institute change:
“Leadership is needed in order for operational research to have optimal impact on improving quality.”
Dr Saloojee highlighted this as an example of the need for public health advocates to bridge the gap between knowledge and action. Audience members reinforced the call for public health activists to ensure that research is translated into both policy and action.
Dr. Jane Goudge, director of the Centre for Health Policy, was the third presenter, shifting the focus to the “long road ahead” in terms of building Health Systems and Policy Research capacity. She identified an asset base upon which South Africa can build making a cogent argument for increased research funding from government and the establishment of career paths in government for health system analysts, the institutionalization of capacity, and embedding research into decision-making processes.
“Public health is an applied discipline. Yet we also need innovation in methods and theory.” Professor Duncan Saunders, discussant.
This session on building the next generation of public health leaders, in South Africa and regionally, was as much one of seeking ‘public health identity’ as it was of exploring innovative pedagogy. By reflecting on what, how and who we train as public health leaders, the parameters of the field, its interdisciplinary nature, and the potential to effect social change were all brought to the fore.
Dr Nicola Christofides highlighted a course unique in Africa known as Social and Behavioural Change (SBCC), which was introduced in 2010 as a core specialisation for the Master of Public Health (MPH) at Wits in partnership with Soul City Institute for Health & Development. Despite being such a new programme, four students have already graduated, with one at the heart of HIV and AIDS policy-making in Malawi, able to influence HIV and AIDS policies and SBCC strategies.
“The Wits MPH recognises that new fields of specialisation are needed to respond to regional needs. The innovative SBCC course embodies the inter-disciplinary nature of public health from fields as diverse as sociology, journalism, nursing, social work and theatre to name a few.”
Building on this theme, the head of the division of epidemiology and biostatistics at the Wits School of Public Health, Professor Tobias Chirwa, outlined a number of innovations for building the region’s capacity for measurement sciences. These included applied field epidemiology, research opportunities at the health and demographic surveillance sites, and short courses for health professionals and individuals in research and clinical trial settings, leading to highly competitive and relevant public health leaders for the region.
“Our graduates are holding senior positions in research institutions such as the APHRC in Kenya and the SA Medical Research Council, academic institutions like Wits and the University of KwaZulu-Natal, and government institutions for instance Statistics SA.”
Public health medicine specialists can contribute to strengthening the country’s health system effectiveness, according to Professor Shan Naidoo, head of the Department of Community Health in the School. He show-cased the MMed in Public Health Medicine (PHM) programme which is a four-year full-time specialist training programme for medical doctors, preferably with health service experience. Public Health Medicine is a growing speciality and the Human Resources for Health Strategy for South Africa states that the appointment of public health specialists at senior managerial levels is crucial for the strategy to succeed.
“This is the largest and most successful MMed (PHM) training programme in the country with 100% throughput. Demonstrating their leadership, registrars have played a significant role in building and running the Public Health Association of South Africa (PHASA), and the South African Medical Association.”
Former head of the WSPH, Professor Sharon Fonn highlighted the School’s strong PhD programme – the number of graduates has more than trebled between 2006 and 2012 – and the flagship Consortium for Advanced Research Training in Africa Programme (CARTA). CARTA aims to build and retain a vibrant African academy able to lead world-class, multi-disciplinary research that impacts positively on public and population health. Established to address the challenges of current PhD training models in Africa and the constraints of an overseas model, CARTA as a consortium is able to capitalise on institutional strengths, maximise exposure and offer opportunities for innovation. More information about CARTA.
The session was concluded with a challenge from Tim Wilson who is a trustee of the Health Systems Trust for delegates to avoid stale ‘like-mindedness’ by constantly seeking a ’totally different perspective’ and bringing this to bear on building the next generation of leaders in the field.
Improving the performance of a health system relies on the efficiency and effectiveness in delivering health services. A session examined this area through the lens of the National Health Insurance (NHI). Representing the public sector, Dr Mark Blecher from the South African National Treasury, examined the achievements and challenges of financing the NHI, while Dr Ayanda Ntsaluba, previous director-general of health and foreign affairs, and now with Discovery Health, presented prerequisites needed for successful implantation of the policy. Despite coming from different ends of the spectrum, both presenters provided an honest account about what is required to achieve this major feat of health system reform.
Dr Blecher emphasised that the vision of the government, through the NHI, was to improve access to quality health services. To achieve this vision, he reviewed a framework that would allow an analysis of the financing mechanisms of the NHI. Key components were presented, including revenue generation, strategies to pool funds and the provision of services. He added that the financing of the NHI must be accompanied by sustained improvements in health services, including the quality of care. Further analysis of these financing mechanisms will be conducted in the ten piloting districts.
However, having reviewed the plans and achievements, some in the audience expressed concern that the piloting lacks mechanisms that ensure learning.
Dr Ntsaluba unpacked the prerequisites to implementing the NHI, taking into account the current health system challenges. He looked at technical and/or managerial capacity and the value of innovation in addressing the current barriers, such as human resources and poor infrastructure. He emphasized the importance of developing and supporting leadership and evidence of this effort is reportedly through the national Department of Health’s Academy for Leadership and Management in Health care.
Although the audience viewed Dr Ntsaluba’s outlook of the NHI implementation as ambitious, considering the challenges, he pointed out that the success of the implementation of the NHI required the collaborative efforts of all stakeholders such as universities and schools of public health and in partnerships already flourishing within the health sector.
This panel discussion focused on the seemingly intractable problem of corruption in the South African health system. The speakers not only provided a broad overview of the challenge, but also described examples of actual interventions and offered possible future solutions.
Professor Dan Ncayiyana, emeritus professor at the University of Cape Town, outlined the historical development of corruption in South Africa. He traced its roots in the Apartheid-era bureaucracy and delineated its trajectory through the homeland system and then finally into the post-1994 dispensation. He suggested that the current battle had to be fought on many fronts, from the introduction of more robust legislation to the engagement of active and vigilant citizenship.
David Lewis, executive director of Corruption Watch, described his organisation’s model of operation in terms of investigating and reporting corruption. He also spoke about Corruption Watch’s encouragement of ‘targeted shouting’ through the identification of ‘hotspots’ and the establishment of online communities of concerned citizens. He then gave specific examples of corruption at both provincial government and facility levels.
The third speaker was Dr Pieter de Jager, a public health medicine registrar in the School. He described an exploratory study that was undertaken in order to understand corruption in the South African health sector. Utilizing agency theory as a conceptual framework, and drawing data from key informant interviews, print media and more than five years of auditor-general reports, the study found that close to R6 billion or one tenth of the total public sector budget was classified as irregular expenditure for the 2010/11 financial year. The conclusion was that corruption appears to be pervasive, deleterious to the health system as it undermines its effectiveness and efficiency and is a threat to meaningful health reforms.
The final speaker, Professor Richard Levin, advocated an approach that was both preventative and curative. With reference to Horst Rittel’s ‘wicked problem’ theory, he described corruption as being complex and multi-faceted. He called for a clarification of the national anti-corruption strategy, the strengthening of leadership and management capacity, a consolidation of the institutional framework and the undertaking of more aggressive action so that those involved in corrupt practices would experience real consequences.
The building was formally opened by the Minister of Higher Education and Training, Dr Blade Nzimande, at a gala dinner in the evening. Click here for the Minister’s speech and details about the new building. The international peer-reviewed journal, Global Health Action, launched a special edition entitled ‘Building New Knowledge’ during the gala dinner to acknowledge and celebrate the academic prestige of the Wits School of Public Health. This open access supplement is available at http://www.globalhealthaction.net/
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