From 17-19 February, the Alliance for Health Policy and Systems Research, with support from the UK National Institute for Health and Care Research, brought senior health policy-makers from six countries to Cape Town, South Africa, for the 2026 Alliance Policy-maker Forum, a three-day gathering designed to provoke cross-country dialogue and collaboration for strengthening evidence-informed health policy.
Co-hosted by Dr Keith Cloete, Head of the Western Cape Department of Health and Wellness and co-chair of the Policy-maker Forum, the 2026 edition marked the first time the Forum undertook its discussions within a health system to facilitate learning. The Western Cape’s health system offered participants direct exposure to how sustained leadership, institutional continuity and long-term investment have shaped health systems performance and supported long-term reforms in the province.
Policy-makers from Ethiopia, Ghana, India, Japan, South Africa and Uruguay examined how governments can make better use of different forms of evidence to guide reform. Discussions reflected mounting global uncertainty, including tighter financing environments and shifting development priorities, and the pressure these shifts place on national health systems. Despite these global shifts, participants underscored the value of the Forum as a space to exchange lessons, test ideas, and build collective responses to emerging challenges.
In particular, participants discussed the tension between short-term political demands and long-term system transformation, including priority areas for health systems research to better inform policymaking for health security and preparedness in rapidly changing contexts. They considered a decision-making framework mapping two variables: the availability and clarity of evidence, and the degree to which stakeholders converge or diverge on policy action. Participants also debated how to measure less visible dimensions of system performance, such as psychological safety, accountability and trust, while addressing practical concerns including policy-making, measuring systems change and leadership succession.
Site visits to a community health center and a tertiary district hospital allowed delegates, including Ms Shenaaz El-Halabi, WHO Representative to South Africa and former Permanent Secretary at Botswana’s Ministry of Health, to engage directly with frontline managers, health practitioners and community health workers. At the community health center, discussions focused on the role of community engagement in governance and accountability. Members of the local community health council spoke about how community representatives contribute to strengthening trust between residents and the health system.
Participants also observed practical efforts to improve service organization under resource constraint. Although still paper-based, patient records are now systematically organized, improving continuity of care and reducing delays. For policy-makers, these examples illustrated how incremental management reforms and community partnerships can produce meaningful improvements, even in settings without advanced digital infrastructure.
A visit to the University of the Western Cape brought together colleagues from the University of Cape Town, the Western Cape Department of Health and Wellbeing, and local researchers to showcase collaboration between health policy and systems researchers and practitioners, joined by Dr Yogan Pillay, Director of HIV & TB Delivery at the Gates Foundation and former Deputy Director-General in South Africa’s Department of Health. Among the initiatives highlighted was the South African Learning Alliance for District Health Systems (SALAD), which is working to strengthen district leadership through workplace-based learning and the integration of leadership development into human resource systems. Presenters and discussants at the university session reflected on the values underpinning this approach, emphasizing the importance of a common passion, protecting and valuing criticism, and the creation of safe spaces within institutions where managers and practitioners can question, experiment and learn from failure. This candid discussion of organizational culture and leadership practice offered an opportunity for policy-makers to reflect on how similar enabling environments might be cultivated within their own systems.
Participants also engaged with the Alliance’s 2025 Thinker in Residence, Professor Asha George, who led a session on health policy and systems research (HPSR) and gender equality, exploring how health policy and systems research can better address structural inequality. Participants shared experiences of persistent barriers facing women in academia and political leadership, including underrepresentation in senior roles and the limits of quota systems. At the same time, some delegates pointed to emerging disparities affecting boys and men in certain contexts, calling for approaches to gender equality that are both evidence-informed and sensitive to shifting social dynamics.
Forum participants underscored the need for sustained cross-country collaboration to navigate a rapidly changing global health architecture and to ensure reforms remain grounded in equity, resilience and long-term institutional strength. They expressed appreciation to Dr Cloete and the Western Cape Department of Health and Wellness for hosting the meeting, noting the value of learning directly from a functioning health system.
Following the forum in Cape Town, some participants also visited Pretoria for a workshop co-hosted with the Alliance and the WHO Country Office for South Africa on the future of health systems.