Tracey Koehlmoos: the 19th Cochrane Colloquium in Madrid

Tracey Koehlmoos¡Hola! from Madrid where the 19th Cochrane Colloquium was hosted last week by the IberoAmerican Cochrane Centre. The theme of this year’s meeting was “scientific evidence for healthcare quality and patient safety.” As all of us – at one time or another – are patients of the healthcare system, the synthesis of interventions to reduce adverse events that impact health and healthcare has universal importance. More than 2300 Cochranites attended the colloquium this year, which featured 126 meetings, 84 workshops, and 514 posters. There was definitely something for everyone; as a health systems scientist, the plenary session that had me rapt was on Friday morning and about “Using evidence to improve health systems.”

The session featured engaging talks by Andy Haines from the London School of Hygiene and Tropical Medicine, Xavier Bosch-Capblanch from the Swiss Tropical Institute, Harriet Nabudere from the REACH East Africa policy community, and my friend and colleague Tomás Pantoja from the Pontificia Universidad Católica de Chile. The presenters brought together the best of the material that has been discussed and developed around the theme of health systems synthesis.

Whereas generally, over the last three years when we have talked about health systems synthesis, it has almost exclusively been to groups familiar with health systems research and its methodology; this was the first time that the general membership of the Cochrane Collaboration has been exposed to the WHO Framework for Action for health systems with its six building blocks, and the seminal work by Don de Savigny and Taghreed Adam “Systems thinking for health systems strengthening,” and thus the broader need for systematic reviews of health systems issues. Tomás had been dealt the daunting task of presenting on the value of Cochrane reviews in developing health systems guidance. He managed to balance the benefits of Cochrane reviews with the need for additional flexibility and new methodologies in order to appropriately address complex health systems issues. (Actually, Tomás has set a new high bar because not only did he take on a difficult task, he presented in Spanish while using English language power point slides.)

It could have been the early hour of the plenary session or that people not interested in health systems simply did not attend, but the anticipated push back from the positivists and methodological purists did not occur despite the lingering tension from those who believe that everything can be boiled down to a p-value. It appears that now there is an understanding of the need to study the “how,” “why,” and “for whom” using systematic review. Perhaps the onus is now on us as reviewers and health systems scientists to continue to develop and test the appropriate synthesis tools to answer these pressing questions.

As always, the Colloquium was over too quickly and I left feeling like there was so much more to read and learn. This Dhaka-London-Madrid-Washington trip is flying by—but thank you to everyone who turned out for the C3 Health breakfast seminar; it was great to share the work on the development of the Bangladesh health system and to share ideas and low-cost, low-tech programmes in which community health workers are making a difference in non-communicable disease outcomes in the UK. Thank you to the United Health group for sponsoring the event.

Also, the launch of Good Health at Low Cost was a fantastic blur of Richard Horton putting members of the author and editorial team panel through a robust and lively round of questioning that included having to stand up by a blue line on the floor—reminiscent of a spelling bee, or maybe a criminal line up. However, instead of not knowing which letters make up multisyllabic words, it appeared that after two years of research and writing, this panel was fully prepared to answer even the most challenging questions about why some health systems were successful in improving the health status of the population while spending relatively little. If you would like to read Good Health at Low Cost, it is now available for no cost at: (Bangladesh is chapter 3.)

Tracey Koehlmoos is programme head for health and family planning systems at ICDDR,B and adjunct professor at the James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh.