Breakout Discussion Groups

Thursday 19 February 2015 16h30-18h00

Group Two: Health systems strengthening, capacity building, community engagement, and empowerment (Room XI)

Facilitator: Mr. Nhan T. Tran, Manager, Implementation Research Platform, Alliance for Health Policy & Systems Research, World Health Organization

Summary

The breakout discussion group on health systems strengthening, capacity building, community engagement, and empowerment attracted varying stakeholders, including member State representatives from the global south and north, representatives of civil society and intergovernmental organisations, as well as other non-state actors.

All parties participated in an open conversation that included comments and suggestions on practices in specific environments, including States, regions and local communities. The conversation included open debate on best practices for strengthening capacity building, as well as the consideration of how best practices in specific contexts could be implemented in other communities, regions and States.

Key themes addressed throughout the session include:

· The need for evidence-based and quality health systems and products that include:

o Comprehensive data collection and analyses to enhance efficiency and encourage best practices that includes:

§ Measuring indicators on access and equality;

o Quality, well-trained health care practitioners and providers (including non-medical staff); and

o Recognition of the benefits of tested traditional medicines and practices, and the development of methods for enabling better integration of evidence-based traditional and evidence-based modern medical treatments;

· The need for transparency and accountability in health systems planning and operations that includes:

o The monitoring of community, regional and national health systems by States and non-governmental organisations in order to:

§ Disseminate knowledge of best practices in health systems strengthening;

§ Elucidate bad practices in health systems; and

§ Encourage cooperation in health systems strengthening between different communities, regions and States;

· The need to ensure equity of access to health systems that includes:

o The need for health systems to be:

§ Affordable;

§ Safe;

§ Complemented by modern technologies; and

§ Ethically-considered; and

o Particular reference was also made to the indiscriminate and universal nature of the right to health, and the fact that all people, irrespective of their nationality, socio-economic status, sex, age, gender, religion, political persuasion, or any other factor, should have access to health systems that enable their right to health;

· The need to have multi-stakeholder engagement and cross-sector collaboration when planning and implementing health system strengthening that includes:

o Open participation from:

§ State governments;

§ Intergovernmental organisations;

§ The private sector;

§ Civil society; and

§ Individuals;

o The use of accessible language that enables all individuals to actively contribute to the health system strengthening discourse within their local communities, regions, States and within the global community;

o Respect for the personal agency of individuals and their right to make decisions that impact their personal, familial, community and national health systems;

o Open conversations and opportunities for information sharing;

o Respect for cultural diversity; and

o The empowerment of women and children in such discourses;

· The need for robust non-medical support in health systems that includes:

o Human resources, that is not limited to:

§ Administrative staff;

§ Research staff;

§ Primary health care professionals (e.g. surgeons, doctors, nurses); and

§ Secondary and tertiary health care professionals (physiotherapists, ophthalmologists, etc.);

o Technological capabilities within health systems, that is not limited to:

§ Medical Equipment; and

§ Modern computers for storing records;

· The need for respect between all stakeholders that includes:

o Doctors and patients;

o Primary and secondary carers;

o The private sector and civil society;

o States and individuals; and

o Healthy and unhealthy peoples;

· The need for decentralising medical manufacturing that includes:

o Encouraging medical and medicine manufacturing in a number of countries, so as to:

§ Increase supply and put downward pressure on prices;

§ Decrease the associated travel costs of products; and

§ Enable greater regional access to medicines and effective health systems;

o Diminishing the strength of corporate interests within the health industry by undertaking the above steps, and thereby facilitating the universal acquisition of the right to health; and

o Ensuring that adequate State regulation overseas the expansion of the medical manufacturing industry so as to ensure the safety of products;

· The need for comprehensive education systems that include:

o Professional development pathways for health practitioners that include:

§ Ongoing training from impartial actors (i.e. not representatives from the pharmacological industry) in the most current and effective ways to strengthen healthcare systems, improve duty of care, and ensure people’s right to health; and

§ Emphasis on both theoretical and practical applications of medicine during training and throughout medical practitioners’ careers;

o Learning systems for all individuals to learn about their right to health that include:

§ Tutorials and classes on basic mechanisms for encouraging health, including, for example, hygiene practices;

§ Human rights training on the right to health and other associated rights;

· The need for adequate financial resources and regulations that include:

o Health budgets comprising a large proportion of total State government budgets;

o Centralised pricing mechanisms that put downward pressure on health services and products;

o Mechanisms for incentivising health care practitioners to work in rural/regional, or other under-represented, areas;

o Greater flexibility from the International Monetary Fund (IMF) and other lenders, that enable more autonomy with health budget financing; and

o Methods for improving efficiency and making financial resources go further and last longer.

Methods for realising health systems strengthening, capacity building, community engagement, and empowerment:

· Recognising that different communities, regions and States have different needs with regards to their health systems, and allowing the international health system to champion flexibility in its work to strengthen national health systems; and

· Realising that the right to health does not exist in a vacuum, and instead, that the right to health will be greatly enhanced by the realisation of other human rights, including, but not limited to:

o The right to water;

o The right to food;

o The right to adequate housing;

o The right to education;

o Etc.

o And thus, adopting a holistic approach towards achieving all human rights will prove advantageous for strengthening health systems and realising the goal of universal access to health.

Finally, it was suggested that the Human Rights Council, and indeed, States, civil society and other actors, could come together in a multi-stakeholder partnership to conduct a Universal Periodic Review (UPR) of the right to health and access to medicines.

Such a method was suggested as a means to strengthening health systems as it includes many of the above themes. For example:

· The UPR method is evidence-based;

· It encourages transparency and accountability;

· It supports equity of access;

· It encourages multi-stakeholder engagement and cross-sector collaboration;

· It includes robust non-medical administrative and research support;

· It facilitates respect between all stakeholders;

· It acts as part of a comprehensive education system; and

· It would advocate for:

o Decentralising medical manufacturing so as to lower costs; and

o Adequate financial resources and regulations so as to achieve the right to health.

In conclusion, the breakout discussion group on health systems strengthening, capacity building, community engagement, and empowerment started the process of closing the gap in understanding on the importance of health systems strengthening. While there is still much to be done in this front, the above themes and suggestions garnered broad-based support and offer us a map of the types of themes that need to be discussed broadly and openly if we are to universally achieve the right to health.