This year - ten years since the WHO's landmark report on Working Together for Health - the World Health Assembly approved a Global Strategy on Human Resources for Health and the secretary-general is convening a high-level commission on health employment and economic growth. These initiatives confirm that health workers play a pivotal and dynamic role in health systems and economies worldwide, whether immediately responding to new and old pandemics and health crises, or in supporting universal health coverage and the sustainable development goals more broadly.
It is now widely acknowledged that health workers' roles and practices; their identities and motivation; their training, support and deployment are at the centre of successes and failures of health interventions and health system functioning. The past few years have seen a proliferation of research on these and others topics related to human resources for health (HRH), drawing from a range of disciplines such as public health, sociology, psychology, organizational and management sciences.
The idea for a reader emerged from the need for guidance on and examples of excellent HRH research, embracing how health workers are creative and dynamic agents best placed alongside patients, managers and policy-makers to address contemporary health system complexities.
In just over two weeks, 169 candidates from 25 sub-Saharan African countries responded to our offer of doctoral scholarships and post-doctoral fellowships anchored by the South African Research Chairs we hold in Health Systems Governance, Complexity and Social Change at the University of the Western Cape’s (UWC) School of Public Health. Apart from those from South Africa, there were applicants from Benin to Zimbabwe, reflecting a massive demand for doctoral and post-doctoral training in the region.
In April 2016, the Collaboration for Health Systems Analysis and Innovation (CHESAI) and the Resilient and Responsive Health Systems (RESYST) Consortium convened a health system governance writing workshop. This workshop brought together health systems and policy researchers from Kenya, South Africa, India, Ghana and Argentina to discuss and develop papers on governance issues affecting low- and middle-income country (LMIC) health systems.
In the previous, very popular, edition of this blog, colleagues from Kenya wrote about their experiences and lessons from this workshop. We now complement this with the reflections of five colleagues working in India, who write about the workshop process, insights about new questions and methods, different understandings of governance, the cross-pollination of ideas and comparisons between the policy contexts of India and Africa.
Inspiring: the view from the workshop venue
Within development debates and applied to national governments, "good governance" is often seen as a loaded term infused with political and value judgements. Yet health system governance is widely seen as a crucial leverage point to generate performance improvements.
But what is health system governance? The common focus on structural rules and regulations in health debates may defuse concern about value judgements, but at the same time ignores the importance of relationships among actors and the multiple institutional drivers of these relationships: history, experience, reputation, customs, beliefs, values. Indeed, governance demands concern for values in every setting.
While health system managers appreciate this, they are often too stretched to incorporate the relational aspects of governance in their day-to-day managerial practice – and so a key challenge for researchers is to think about how such aspects of governance can practically be infused into health systems.
Welcome to the brand new CHESAI website, and particularly to this blog space. We are hoping that, going forward, this will become a space for sharing of ideas and lively debates on issues pertaining to health policy and systems research and practice.
The Collaboration for Health Systems Analysis and Innovation set out in 2011 to expand and strengthen the South African and African health policy and systems field by building and strengthening networks of people, knowledge and ideas.