Health Policy and Systems Research in South Africa: Directions and Specializations
By Tracey Naledi
Prof Lucy Gilson started the workshop by providing context and sharing highlights from the first PHASA workshop in Health Policy and Systems Research held in 2012. She explained to the participants that “Health systems are dynamic and interconnected systems at whose heart are people” and that for us to improve these health systems, we have to understand them better. Health Policy and Systems Research, she said, seeks to understand:
- “What health systems are, how they currently function & why they function like that:
- What needs to be done to strengthen them:
- How to influence policy agendas on health system development:
- How to develop and implement policies in ways that strengthen health systems.”
Some of the challenges within the South African health system identified at the 2012 workshop included the “gaps between research evidence and practice, as well as between policy and practice, contradictory policies, leading to implementation failure; a lack of understanding of what factors guide implementation at the coal face or front line of the health system; a lack of attention and understanding of the complexity of health systems; little shared understanding about the terrain of HPSR”. At the end of the 2012 workshop, Prof Gilson reported that the participants prioritized the “development a ‘community of practice’; building acceptance of HPSR in the South African public health community and the world of policy and practice and making greater efforts to better link and align research, teaching and practice in the field.”
The aim of the workshop in 2015 was to discuss the role of HPSR in South Africa and future directions that could possibly be considered by a PHASA special interest group. Prof Helen Schneider (UWC) facilitated a panel discussion with Dr Jane Goudge (Wits Centre for Health Policy), Dr Thameshree Naidu (UKZN) and Dr Tracey Naledi (Western Cape Department of Health) to hear the different perspectives on the potential role for HPSR. Workshop participants also shared their insights and experiences during the panel discussion and in small groups. The group was unanimous in its assertion of the important role for HPSR in South Africa and identified broad areas of potential focus. The workshop was very exciting, vibrant with thought provoking discussion. These discussions informed the establishment of a PHASA special interest group (SIG) in HPSR. This SIG will be taking forward the HPSR agenda. The participants were encouraged to use social media #HPSRSA to continue discussions on the subject.
Health Committees – vehicles for democratic governance in the South Africa health system
Fundiswa Kibido, Health and Human Rights programme, University of Cape, email@example.com
Leslie London, Health and Human Rights programme, University of Cape, firstname.lastname@example.org
Community participation is a key element of the primary health care (PHC) approach and has been shown to increase access to health care, promote community ownership of health services and enhance the responsiveness of health systems. Yet, even though our National Health Act mandates the establishment of health committees as the interface between communities and the health services, the Act leaves the exact roles and functions to provincial regulation. As a result, there is much confusion and a wide variation in the practices of community participation across the country. This undermines the effectiveness of health committees and the responsiveness of the health system.
The workshop, attended by participants from services, research institutions, advocacy groups and NGOs from around the country and other counties in the region, shared experiences of work to build health committees in South Africa as vehicles of democratic governance. Research findings from a review of policies on health committees around the country, and of evaluations conducted of health committee functioning in the W and E Cape were shared, and highlighted the critical importance of recognising health committees as agents for community voice in democratic governance. Too often, health committees are reduced to structures serving the over-worked and burden facility staff, when they should be exercising accountability and governance functions. Confusion about health committee roles undermines their potential to act as the voice for the community. A DVD made with health committees and providers in the Cape Metro Health District was used to illustrate both the successes and challenges of building health committees and relationships with facility staff. Central to strengthening health committees is the need to reinforce transparency, respect and trust.
Participants were able to reflect on their own experience and take away information, resources and contacts that will help them contribute to strengthening community participation structures in health for their contexts.
Strengthening leadership and management through work-place based training and capacity development interventions
This workshop was facilitated by Lucy Gilson and Maylene Shung King from the Health Policy and Systems Division at the University of Cape Town and attended by 32 participants, who were all keenly interested in the concept, application and utility of workplace learning.
What is workplace learning? There are numerous definitions, as indicated by Gina Teddy in her overview presentation that addressed the definitions, theories and applications of workplace learning. Simply put, it is learning in and through the workplace, mostly informally as opposed to through accredited courses, but occurring in a concerted, deliberate and co-ordinated manner. (Formal courses can strive to include workplace-based learning elements as well, though.) Furthermore, workplace learning requires a work setting that recognises the importance of allowing health workers and managers to learn in an ongoing fashion, and that supports and facilitates learning. Gina’s presentation, together with an overview paper, provided the necessary context and theoretical basis for the workshop discussions.
Participants all gave their ideas of what workplace learning means for them. Participants roughly belonged to three groups: Frontline service providers in various positions, who were keenly interested to know how they could benefit from workplace learning and what practically could be done to enhance their own learning; Senior managers and policy makers who are grappling with the systemic challenges and constraints, wondering what they could do to make workplaces more conducive to ongoing learning, and wanting to know how to help newly trained managers to plough their knowledge and skills back into the workplace; and Representatives from various kinds of training institutions (formal higher education and non-governmental agencies), musing about how their offerings should and could change to better support learning in the workplace.
Jane Doherty presented findings from a recent evaluation of the Oliver Tambo Fellowship programme, a post-graduate diploma in health management run by the University of Cape Town, with more than 200 alumni in various managerial positions. She highlighted how managers who graduated from the course had benefitted and applied their learning back in the workplace. She also shared examples of how colleagues in other countries apply workplace learning, as gleaned from a recent three-day conference on the subject convened by Lucy Gilson and involving colleagues from several different countries.
At the end of the workshop participants strongly felt that an ongoing conversation on workplace learning was necessary. At the very least, they felt that an annual workshop at PHASA was warranted. They also suggested platforms through which ongoing postings of experiences and ideas could be shared among the group.
Integrative, complementary, alternative and traditional health practices I-CATHP
The I-CATHP workshop was facilitated by Professor Gail Hughes (interim chair of I-CATHP SIG) on 7 October 2015 from 12h45-15h45 pm. There were 13 participants attending the first held workshop of this newly formed SIG.
The agenda was as follows:
- Welcome, Introductions, Overview and Expectations
- Background on I-CATHP SIG
- Overview of I-CATHP globally and in South Africa
- Useful Tools: 1. E-learning on THM and clinical trials and 2. MOUs/MOAs for working with community/Traditional Practitioners
- Discussion and next steps to advance the topic and SIG
The participants represented a diverse group: health professionals (doctors, nurses); herbal science researchers; medical anthropologists, etc. and there were also participants from other parts of Africa (e.g. Uganda) and Europe (UK).
Key points mentioned in the workshop for further exploration and discussion :
- To definitely conduct an annual workshop with variety of key topics and speakers.
- Encourage students to participate.
- Sponsor a I-CATHP session at the annual PHASA meeting; either poster and/or oral presentation session.
- Focus on Community Health Outreach workers as key community extenders for I-CATHP
Climate Change, Air Quality and Health: Impacts of Energy Choices
Peter Orris and Rico Euripidou
“Climate change is the biggest global health threat of the 21st century… We call for a public health movement that frames the threat of climate change for humankind as a health issue.” — The Lancet and University College London Commission on Managing the Health Effects of Climate Change, 2009.
Nearly all aspects of modern life, in all parts of the world, benefit from access to energy. From powering equipment to provide medical care, to prolonging daylight hours to enable studying, energy access can support and enhance health in myriad ways. However, there are important health considerations in the generation, distribution, and consumption of various energy sources, arising from their impact on social, environmental, and economic systems. Leading medical journals and health professional organizations have begun to endorse the evidence and amplify the message that air pollution and climate change both pose serious challenges to global public health and therefore must be addressed as public health issues.
According to the WHO, approximately 7 million premature deaths per year result from exposure to air pollution, making it the world’s largest environmental health risk. Approximately half of the burden is attributable to outdoor air pollution, which comes from the combustion of fossil fuels and contributes to deaths due to ischemic heart disease, stroke, chronic obstructive pulmonary disease, lung cancer, and respiratory infections. The burning of fossil fuels is also responsible for the majority of greenhouse gas emissions that contribute to climate change. By causing or intensifying extreme weather events, food and water insecurity, and the migration of infectious diseases, climate change exacerbates global health challenges.
The global public health community has a unique opportunity to serve as an interlocutor between the scientific evidence on the harmful effects of fossil fuel-based energy generation and the health benefits of policies that mitigate air pollution by transitioning to clean, renewable energy. Around the world, public health professionals are beginning to engage on the health impacts of air pollution and climate change by advocating for health impacts to be considered in energy decision making, and promoting the health cost savings afforded by healthier energy choices. In countries ranging from India to South Africa, Poland to the Philippines, Australia, the United States, and China, health professionals are increasingly documenting the negative health impacts of the dirtiest forms of energy such as coal, and the health benefits of clean, renewable energy such as solar and wind. Public health associations and other health institutions in many of these countries are taking positions that advocate for a move away from fossil fuels and toward a healthy energy future. To find out more, visit the Healthy Energy Initiative. www.healthyenergyinitiative.org
The following are elements of discussions and actions from the workshop:
- The public health sector should provide support to communities affected by coal and other extractive energy industries.
- Advocate for health impact assessment and health economic evaluations to be integrated in decision-making on energy projects and energy policy i.e. with considerations for worker safety and health; environmental impacts; air, soil and water pollution; displacement of communities; economic and social disruption; health equity concerns; and contribution to climate change.
- Engage a broad cross section of health sector actors in developing and advocating for healthy energy policy.
- Build capacity for a larger and more diverse group of health sector voices to articulate for the energy transition.
- Seek out partnerships with complementary global health movements (e.g. non-communicable diseases, social determinants of health, and health systems strengthening).
- Lead by example by investing in clean energy solutions for our workplaces, health centres, hospitals and health systems, and using our purchasing power to decarbonise the health care systems and supply chain.