At a side event during this year's UN General Assembly, co-hosted by the Alliance and Health Systems Global with support from the Government of Georgia, panellists highlighted the need for further investments in health policy and systems research to achieve universal health coverage.
The 74th session of the United Nations General Assembly kicked off last week with leaders signing a landmark political declaration on achieving universal health coverage by 2030. It is an important declaration that recognizes that health is a foundation for reaching the other sustainable development goals (SDGs). And while the declaration is substantial – covering everything from improving access to essential medicines to increasing the health workforce and making care affordable – it largely glossed over an essential ingredient for strengthening health systems.
‘Universal health coverage: Unattainable without evidence’, was the side event convened later that week in the United Nations Headquarters by the Alliance for Health Policy and Systems Research and Health Systems Global with sponsorship from the Republic of Georgia. The event featured a distinguished panel of speakers from the world of health policy and systems research.
“Without data-driven policy-making, decision-making and monitoring and evaluation of the progress and the challenges, it will be impossible to attain the universal health coverage goals”, stressed Mariam Jashi, the Chair of the Education, Science and Culture Committee of the Parliament of Georgia, as she opened the event.
Though other panelists went farther. They argued that, to create accessible, quality, affordable and equitable health systems, more – and more relevant – political and social science focusing on health systems strengthening was required.
Investing in ongoing learning “should be part of good programming”, asserted panelist Stefan Swartling Peterson of UNICEF. Most funders require around 5% of grants be allocated to monitoring and evaluation, “but we rarely question what that monitoring and evaluation is”. There need to be mechanisms for course correcting, he continued, even if that sort of research is difficult to publish. “Research is a scary word. It’s about programme learning. My slogan these days is to fix the airplane while you’re flying it. Don’t wait for the crash end-line evaluation.”
Other panelists emphasized the need for closer relationships between researchers and policy-makers, advocating an embedded research approach. Dr Rajani Ved, Executive Director of the National Health Systems Resource Centre (NHSRC) in India gave an example of an upcoming priority setting exercise that they will be undertaking where practitioners from across different states will articulate challenges they are currently facing in trying to bring down childhood mortality rates. Researchers will then transform those into research questions and use different research approaches to answer those questions in a timely manner.
Timing was raised as a critical issue for ensuring research informed policy and practice. And recognizing the political nature of discussions around universal health coverage was also emphasized. To get political buy-in, politicians need to be able to show progress during an election cycle. Dr Peterson suggested that there is, therefore, a need for researchers to develop research projects with indicators that can move in a five-to-ten-year timeframe.
Despite the speed of politics, both Dr Ved and Lola Adedokun, Director of the African Health Initiative at the Doris Duke Charitable Foundation, stressed that long-term investments in platforms, institutions and individuals can pay dividends. Ms Adedokun also suggested that investing in second-line leadership has helped their projects succeed, despite changes in politics and despite election cycles. “By investing at the district level and in the research institutions and supporting what we think of as rigorous questioning – it leads to a culture change. And if you embed that culture change of questioning and looking at data to answer those questions, it doesn’t really matter if there’s a new president in place. That’s what makes a resilient system.”
Investments in local capacity were stressed all around. Dr Ved suggested that having domestic funding added legitimacy and credibility their work. When asked about what big multilateral organizations can do to support better the generation and use of evidence, Dr Peterson recounted that when he visits country offices and is confronted with colleagues concerned that they don’t know enough about an issue in a country, he always asks them who their local academic partners are. He went on to suggest that funders should invest in building the capacity of those local academic partners and then work with those partners to shift incentives away from strictly academic publishing and toward embedded research.
Wrapping up, Professor Sara Bennett from Johns Hopkins School of Public Health underscored that, “universal health coverage is a hugely ambitious agenda and we need to pull together not only the political commitment, but the civil society commitment and also the commitment of researchers and those who work with data and evidence on a day-to-day basis”. She suggested that, while much progress has already been made and there is a lot of innovation on this front, we need to continue to break down the barriers between the different communities to ensure we are all working to support better health and well-being for all.