In the shadow of the gleaming steel Beijing National Stadium—the famous “bird’s nest” built by starchitects Herzog & de Meuron for the 2008 Olympic Games— 1,775 participants from over 110 countries gathered to hear the latest on Health Systems Research, a new field designed to provide evidence for policy decision making.
A formerly “orphaned” subject, the field has gained momentum since the WHO convened the First Global Symposium on Health Systems Research in Montreux.
Over the conference’s four days there were nearly 200 program events including keynotes, plenaries, concurrent sessions, satellites, posters, films and informal discussions and debates.
If you couldn’t make it—or were not able to attend the various private sector-related sessions—here are my CliffsNotes.
New findings about health marketplaces in low- and middle-income countries
“An effective health system can create order between command and control, and chaos,” said Gerry Bloom to an above-capacity room of students and researchers interested in Complex Adaptive Systems, an admittedly “abstract” theory about health planning amidst tremendous development, urbanization, and change in emerging economies.
Dr. Bloom said policy makers have an imperative to understand health markets, including the “blurring” between the public and private sectors.
Or as David Bishai put it, in a somewhat-unrelated homily on John Snow, “the unseen forces in the world may be much more powerful than the visible.”
Several speakers mentioned the importance of understanding the dynamics of formal and informal health markets, and traditional vs. nontraditional approaches to healthcare delivery. Society participants surveyed also voted for more research on topics including “the balance of sectors, including informal, private, and public.”
Only with a deep understanding of these dynamics including an understanding of the various influences exerted by public, private, and informal providers can policy makers “take off the blinders” (as one World Bank researcher put it) and enact successful strategies to strengthen the entire health system.
Among the findings presented on health markets:
Informal providers in Bangladesh, India, and Nigeria are highly respected members of their community, with higher levels of education than the community average, and some sort of training under their belts. Yet, according to a panel organized by CHMI and moderated by Results for Development’s Gina Lagomarsino, their level of organization and connections to the formal health sector varies from country to country. Researchers said that leveraging informal providers could help countries achieve universal health coverage.
Emre Özaltin mapped facilities in Cambodia’s health marketplace, finding ten times the government-estimated number of private providers; Private and non-medical providers—quacks, monks, traditional birth attendants, and other types—had much less training than the local people estimated.
A stakeholder mapping exercise by Fatima Khatun from ICDDR’B in Bangladesh found that a telephone service linking consumers and informal providers to on-call physicians was controversial to many in the health system, such as formal healthcare providers, local government authorities, pharmaceutical companies, and patients.
Poor patients often ignore TB symptoms for weeks; thus, India and China are increasingly leveraging village doctors and informal providers to expand and strengthen TB DOTS treatment. Research by Winnie Yip of Oxford has found that building in financial incentives for referring up patients with TB symptoms is critical.
Health market innovations are showing results and scaling up. Researchers presented, in traditional and multi-media formats, on the impact and expansion of several innovative programs designed to help the poor access quality health services in the health marketplace.
Marie Stopes International researcher Dinh Thi Nhuan said the partial franchise of government health communes in Vietnam, the “tinh chi em” program, increased utilization of family planning services by five fold. Client satisfaction also increased significantly.
The innovative platform Heartfile, providing transparency for donors funding health services for the poor in Pakistan, now receives funding from the World Bank and local corporations (watch this video to learn how the platform works).
A government-funded mobile health service offered by HMRI in Andhra Pradesh screens for diabetes, heart disease, and other non-communicable diseases, successfully encouraging referred patients to turn up at facilities.
The Accredited Drug Dispensing Outlets (ADDO) improved access to quality medication in Tanzania, as this MSH-produced, 8-minute film explains (see also these photos of an ADDO pharmacy, from a CHMI trip in April).
Kadi, a film produced by the Gobee group with the Population Council and Gates Foundation, effectively parsed the design of Kenya’s output-based aid voucher program—and portrayed the urgency of expanding access to quality maternal healthcare for all women.
The Rajiv Aarogyasri Healthcare Scheme of Andhra Pradesh, India, is being evaluated by Prabal Singh, Sofi Bergkvist, and ACCESS colleagues to determine if it improved equity of access to healthcare in the state.
The UCSF Social Franchising Community of Practice is developing a set of standardized metrics to guide performance measurement of social franchising programs.
A contracting program in Malawi with a faith-based provider improved access to facility deliveries and antenatal care, but overrunning costs and a lack of protocols threatened to undo a promising model.
We will be posting more detailed summaries of many sessions listed above in the weeks to come, so please keep checking this site if you want to learn more.
For more about takeaways relating to the private sector from this conference, visit the Future Health Systems blog, surf Twitter for 140-character updates, check out CHMI’s Flickr feed for photos, and our Vimeo page in the coming week.