At the Sixth Global Symposium on Health Systems Research (HSR2020) from November 7-12, ThinkWell joined over 2,000 policymakers, practitioners, and researchers from more than 100 countries to “explore how we can build health systems which improve people’s health and are socially just.” Some of our Kenya, Burkina Faso, Philippines and US-based staff shared their take-aways from the event:

Boniface Mbuthia, Technical Advisor, Kenya

  • While more funding allocations are needed for healthcare, health leaders must first ensure more effective use of existing funds to deliver quality healthcare.
  • Partnerships between government and non-governmental actors can build synergy that can catalyze how health systems deliver universal health coverage goals.
  • Health system leaders can use evidence from research and data analytics to re-engineer how health systems respond to disease burdens and emerging health threats, including Covid-19.
  • Evidence-informed decision-making in health systems can foster collaboration between policy makers, decision makers, and communities.

Pierre Marie Metangmo, Country Director, Burkina Faso

  • To move towards universal health coverage (UHC), health leaders must adopt strategic purchasing approaches that balance competing health policy objectives.
  • It is essential that global and national leadership invest in increasing health policy and systems research (HPSR) capacity. This will lead to more coordinated action and a strengthened learning agenda.

Maria Yap, Senior Technical Advisor, Philippines

  • Investments in health projects should fund impact measurement. But there should be a balance between funds for impact measurement and funds for actual program activities.
  • Investing for impact in health can be sustainable through a blended financing model where grant capital accelerates organizations’ preparedness to comply with debt financing requirements. Coupled with this, flexibility and additional capital from grants prevents health-focused social enterprises from falling into the debt trap. This is emerging as a new way of adding capital by bringing in private sector players that aim for not only financial but social returns. Additionally, private sector players bring a different perspective to ensure financial sustainability of health and development initiatives.

Anooj Pattnaik, Deputy Director of Learning, United States

  • Health leaders, from national and district policymakers to health facility managers on-the-ground, can use emerging health systems thinking techniques and methods to better diagnose, interpret, and address routine challenges. Researchers and health system decisionmakers should move away from the static representations of health systems to something more adaptive and reflective of the complex interactions across health systems.
  • Health systems can be improved by looking through the lens of improving the health of the poor, vulnerable, and most needy. From research to practice, the field needs to focus on how each of these components can be improved and aligned to prioritize equity. This needs to be done with an eye to the future, as digital innovations and increased connectivity present exciting opportunities to strengthen health systems and expand access.

ThinkWell’s Posters and Presentations

ThinkWell staff, primarily from the Bill and Melinda Gates-supported Strategic Purchasing for Primary Health Care (SP4PHC) project, had numerous posters and presentations that were featured at HSR2020.  These are briefly summarized below with links to view them:

A Stakeholder-based Approach to Assessment of Barriers to Climate Change Adaptation (CCA) of Local Health Systems in an At-risk Province in the Philippines: Health system adaptation to climate change (CCAH) requires building on core health system functions and working with actors outside the health sector. Jemar Anne Sigua, Geminn Louis Apostol, Mary Camille Samson, and Leoncio Abiera Jr. mapped the Filipino health system stakeholders involved in CCAH to understand their relationships and to identify the barriers and facilitators to implementing CCAH strategies in a provincial health system. Based on their findings, the authors proposed recommendations in strengthening health system awareness and action towards CCAH. The presentation was be presented at HSR on November 25. It can be viewed here.

Facilitators and Barriers to Engaging Private Primary Care Providers in the Delivery of Family Planning Services in the Philippines: In the Philippines, the supply of family planning services has not kept up with rising demand. The country’s 2019 UHC Law presents an opportunity to improve family planning access. The government can do this by leveraging the country’s vibrant private reproductive health sector that currently offers limited clinical family planning services. Geminn Louis Apostol, Viviane Cen Apostol, Kate Sheahan, and Matt Boxshall’s research presents recommendations that can help make this potential a reality. ThinkWell will continue to work with partners in PhilHealth, PhilHealth, the Ministry of Health (DOH), and others to develop, test, and learn from these interventions. The poster can be viewed here.

Reproductive Health Voucher Schemes in Uganda: Key Lessons for the Future: Over the past decade, Uganda has used voucher schemes to improve low-income people’s access to family planning (FP) and maternal, newborn, and child health (MNCH) services. In early 2020, ThinkWell and the Uganda Ministry of Health (MOH) collaborated to study the latest two voucher initiatives’ experiences. Tapley Jordanwood, Angellah Nakyanzi, Espilidon Tumukurate, Eric Tabusibwa, James Mwaka, Anooj Pattnaik, Sarah Straubinger, Flavia Moi, and Sarah Byakika captured what the voucher schemes have achieved and distilled what can be taken forward to future health system purchasing reforms. The poster can be viewed here.

Purchasing Arrangements at County-level in Kenya: ThinkWell’s Strategic Purchasing for Primary Health care (SP4PHC) team in Kenya supports a program that combines strategies at the national and county levels to improve how public funds are used to pay for primary health care (PHC) services. Boniface Mbuthia, Felix Murira, Shano Guyo, Daniel Koech, and Nirmala Ravishankar completed a rapid situation analysis to understand county-level purchasing practices. The full report can be viewed here and the poster can be viewed here.

Development of a Competency Certification Framework for Primary Care Providers in the Context of Universal Health Care in the Philippines: The Philippines’ UHC Law presents an opportunity to strengthen primary care. To do this, primary care providers must be adequately supported. Louella Patricia D. Carpio, Madeline Mae Ong, Viviane Cen Apostol, and Maria Eufemia Yap created a guidance framework for the primary care certification of health care providers. This framework can help produce primary care providers who will effectively promote health and make the health system more responsive to the population’s needs. The poster can be viewed here.

Understanding Health-Seeking Behavior for Inpatient Care in Antique and Guimara: Christian Nuevo, Pura Angela Co, Helena Alvior, and Mary Camille Samson from ThinkWell’s Philippines team completed a study to describe inpatient care health seeking behavior patterns in the provinces of Guimaras and Antique. They explored factors that affect utilization of inpatient healthcare services. Their study also aimed to assess the potential role of healthcare provider networks in improving access to and delivery of health services. The poster can be viewed here.

Written by Geminn Louis Apostol, Jemar Anne Sigua, Mary Camille Samson, and Leonicio Abiera Jr.

UPDATE: The presentation can be viewed here.

The Global Climate Risk Index 2020 ranked the Philippines second on its list of countries most affected by extreme weather events related to climate change in 2018. Building health system resilience in the context of climate change requires a response that is anchored in multisectoral collaboration. This type of collaboration can ensure coordination and synergy of programs and policies beyond the health and environmental sectors. ThinkWell’s Philippines team conducted a study to understand how different stakeholders respond to issues in climate change adaptation in health (CCAH), and how they may be effectively mobilized to further strengthen CCAH initiatives on the ground.

The province of Antique, located in the Western Visayas region of the Philippines, is classified as a province with high risk of climate disasters. Fifteen out of its 18 coastal towns are prone to extreme weather events, such as cyclones and storm surges. In collaboration with the Provincial Health Office, we conducted participatory stakeholder and qualitative social network mapping of CCAH stakeholders in Antique. We found that the CCAH agenda in Antique is largely driven by the environmental sector, while health and other sectors fall behind in terms of knowledge, awareness, and resource commitment. The qualitative social network mapping revealed that there are minimal interactions between stakeholders in different sectors when it comes to CCAH initiatives. The flow of money, information, and accountability is largely siloed within sectors.

We also conducted cognitive interviews to determine barriers and facilitators to implement CCAH strategies and initiatives in Antique. We analyzed these against the six themes of the country’s National Climate Change Adaptation in Health Strategic Plan for 2014-2016. Stakeholders emphasized that while Antique already has certain systems, programs, and policies in place, effective implementation is hampered by a lack of leadership and political will resulting in a health system that is more reactive than proactive to climate change-related events. To further galvanize multi-sectoral participation in CCAH, we believe that national and local governments should identify specific linkages and entry points between CCAH and other sectors, which can be used to anchor concrete multi-sectoral collaborations.

Our study suggests that stakeholder knowledge and awareness are key drivers for their support and resource commitment to CCAH initiatives. Inter-professional education at all levels can therefore be an important lever to increase commitment. National and local governments should also clarify the areas of responsibility and accountability of different sectors in the implementation of CCAH strategies to ensure multi-sectoral results. Ultimately, all sectors within and beyond the health system are enjoined to work together in addressing larger socio-economic determinants that influence climate risk, and only then can we truly push for climate-resilient health systems and communities.

To find out more about the study, join our presentation, “A stakeholder-based approach to assessment of barriers to climate change adaptation of local health systems in an at-risk province in the Philippines,” on November 25, 2020 at the Phase 2 of the Sixth Global Symposium on Health Systems Research, organized by Health Systems Global, under the track Health System Resilience and Adaptation to Climate Change: Lessons from Developing Countries.