The health systems’ movement has all the positive energy of an activist cause, but still lacks a cohesive narrative

I maybe preaching to the choir when I say this, but this week’s Third Global Symposium on Health Systems Research is a clear indication of something special in the history of global health movements.

Other global health causes – and I’m talking as a 15-year veteran of the field here – follow one of only a few distinct trajectories. They may start off as a neglected issue that through persistence, passion and persuasion by committed advocates slowly gains the necessary international attention to set off the domino effect – HIV and malaria are cases in point here.

Perhaps, like many of the neglected tropical diseases, the advocates and passion are there, but when they get to the international level they are somehow still side-lined, never quite winning the battle of political priority against other, more eye-catching, issues.

Or, worse, they never really get the international attention in the first place – or at least not the kind that leads to actual health improvements (think leprosy, mental health, maternal mortality).

However, the health systems movements bucks all these trends. Why? The key differentiating factor is the very fact that it is not a global health cause per se. Instead, health systems strengthening is the catch-all solution to global health problems that has been independently arrived at by multiple stakeholders at all levels of the policy-financing-research-implementation chain.

Health systems strengthening is now a clear political, academic and international priority simply because it makes so much sense – economically, rationally, and emotionally – to so many people.

However, what seems like an advantage can also be a risk. The trouble with several different constituencies all arriving at the same solution is that they all have their own definition of what that solution actually is. And this lack of a cohesive narrative about health systems is as clear at HSR2014 as the energy and smiling faces are.

The problem is, while policy makers, donors, international organisations and researchers may be using the same words and talking about similar topics, the language, culture and contextual framework of each of this constituencies remains starkly different.

The result is that policy makers are still not really using evidence in their decisions; donors are not really investing in evidence generation or reporting, or promoting evidence-informed programme design; and researchers are still not really answering the questions that decision-makers – whether in government, donor agencies, international organisations, or implementation partners – need answers for.

If we, as health systems enthusiasts, continue on this road of applying our own definitions to the problem and its solutions – and allowing others to do the same – we will be missing a huge and unique opportunity to capitalise on the convergence of interests and priorities that the health systems movement represents right now.

Importantly, Health Systems Global and their very impressive team of local conference organisers and facilitators have created the very conditions for solving this problem, as well as highlighting it, by bringing all relevant stakeholders together in the same place. And infusing the gathering with such enthusiasm for change.

Delegates from all constituencies now need to take up the challenge. If you are a researcher, why not strike up a conversation with an implementing partner organisation like MSH? If you are a policy maker or a health service manager, why not go and ask the London School of Hygiene and Tropical Medicine how you can work together? And for the World Bank, WHO and other international organisations – why not try to promote collaboration between policymakers, researchers and implementers, rather that reinforcing the divisions between them?

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