Friday, 20 December 2013

The 4Cs of the Health Systems in Asia Conference

By Jeff Knezovich, Policy Influence and Research Uptake Manager, Institute of Development Studies

During the Health Systems in Asia conference last weekend in Singapore, I was able to identify a clear trend. No, not pluralism in Asian health systems, we already knew that one.

But rather, on two of the four days the closing thoughts from different speakers involved 4Cs. JK Lakshmi, in discussing mixed human resources on Saturday suggested that:
(OK I missed capturing one of the ‘Cs’ in that Tweet – I think it was ‘condition’)

And then on Sunday, Dina Balabanova, in describing an analytical framework for analysing new cases for Good Health at Low Cost 25 Years On, described her analytical framework as:
In keeping with this important new trend, I’ve decided to frame my blog similarly. And so I present to you my four takeaways from the conference using the same ‘4C framework’:
  • Confucius: In opening the conference, Professor Tan, the President of NUS, presented on the ‘tangled web of health’, starting with a quote from none other than Confucius. ‘The beginning of wisdom is to call things by their proper name’, he noted. Perhaps Professor Tan himself is very wise, as this proved to be an important theme throughout the conference. Much of the discussions throughout were centred on describing Asian health systems as they actually are: messy, pluralist systems with diverse actors working with diverse aims and intentions. It’s too easy to fall into the trope of considering health systems only from a governmental perspective, but the Bangladesh example, which was trotted out time and again throughout the conference, should serve as a good case against doing so.
  • Context: This ‘C’ was present in both Lakshmi’s and Dina’s frameworks, and I couldn’t leave it out of mine. The winner of my favourite quote from the conference competition definitely goes to T. Mirzoev from the University of Leeds who proclaimed something to the effect of: ‘Too often we social scientists draw a box around everything and call it context. But we need to unpack that to really understand what it is about the context that matters’. Too true! He was presenting on the similarities and differences in health policy processes in Nigeria and India. One finding was that Indian policy-makers relied much more on locally produced evidence than their counterparts in Nigeria. However, they also analysed different types of policies and found little difference in each of the contexts in how the different types of policy were approached. It's a great example where only part of the context matters.
  • Communication: At the previous Health Systems in Asia conference, one of the clear foci at the time was the notion of ‘poly-centric governance’ as a response to pluralistic health systems. And while it was certainly touched upon this time, a very different response to pluralism was foregrounded: Information and Communication Technologies (ICTs). Part of a pluralist model is a questioning of the overall health knowledge economy. Information asymmetries, where doctors and other health professionals control access to information about health, necessarily start becoming more balanced in pluralist systems. Patients (AKA health consumers) need to be able to navigate the disjointed system, and ICTs are proving an interesting way to do so, though maybe not in the way mHealth experts are imagining. Several studies presented at the conference found that text messages as part of health promotion campaigns were mostly just deleted without being read. Linda Waldman from IDS, who presented on an FHS-related study in Bangladesh, noted that people were using mobile phones for health there not to call health lines, but rather to call several trusted friends or family members who could provide advice on which health approaches and services to use. She even noted an example of calling a cleaner who worked in a hospital for health information – an example that shows just how ripe this area of work is for disruption.
  • Coverage: The closing plenary session took a deeper look at the U, H and C of universal health coverage (UHC) in Asia. Quite frankly, it was one of the most constructive discussions on UHC I’ve seen. Several of the panellists argued that, when it came to coverage, the discussion of ‘breadth’ (i.e. the number of people covered) had totally overshadowed discussions of the ‘height’ of coverage (i.e. the proportion of total costs covered) and the ‘depth’ of coverage (i.e. which services are actually catered for). The latter two are critical in Asia, where an ageing population is increasingly burdened by non-communicable diseases (such as diabetes, hypertension, etc.).

We livetweeted throughout the conference, and have captured a good lot of the discussion (including the live Twitter Q&A for the closing plenary) in a Storify, in case you’d like to explore the conference further.

And after you have a look, I’d be curious – what other ‘Cs’ am I missing?