Qian Li, Raoul Bermejo III, Kopano Mabaso: Young researcher’s perspectives on health systems research

Qian Li, West China Centre for Rural Health Research & Development, Sichuan University, Chengdu, Sichuan, China.

While we young researchers come from diverse backgrounds and careers, we share a common desire to dedicate ourselves to strengthening the health systems of our countries. I received medical training and I was once a doctor in an urban hospital in western China. It was my childhood dream to be a doctor as I wanted to help people in need.

However, during my practice, I was frustrated when I saw some patients eventually giving up on their treatment because they couldn’t afford the expenses. I also noticed the deteriorating relationship between doctors and patients in my country. In some extreme cases, doctors were even attacked by grieving and frustrated patients. I couldn’t help but ask: why is there such a big difference between my ideals and the reality? Can I make a change? How?

Fortunately, chances came. I quit my clinical job and started a career in health system research. It turned out to be the right decision. Now, China is moving towards a welfare state so that patients won’t be too poor to seek care. In the future, doctors won’t need to be worried anymore about their safety while giving care. Each individual will be entitled to better health and services. Everyday I see change is indeed possible through research to strengthen health systems.

My story and China’s story are certainly not unique. Many of us chose this path because we also believe that if not us, who? If not now, when?  That’s the reason why we were in Beijing, at the Second Global Symposium for Health Systems Research.  Although the journey towards universal health coverage is sometimes very steep, it is certainly one that is possible and worth striving towards.

Raoul Bermejo III, department of clinical epidemiology, College of Medicine, University of the Philippines, and Philippine Health Insurance Corporation, Manila, Philippines.

The symposium felt part of a personal and collective journey. While it was easy to feel small in an ocean full of giants in the field, I was able to add my emerging voice to other young voices and be heard. The “Emerging voices” observed and appreciated the explosion and mainstreaming of innovative methodologies at the symposium. We have moved beyond investigating what works and now we are diving into the whys and the hows. We saw health systems research become cutting edge science.

The symposium created space for fresh, raw, young, and dynamic ideas to emerge, but we felt that there is room to grow that space especially for researchers from developing countries. That space remains narrow and many of our colleagues still face significant barriers including those related to mobility and gender. We almost missed one emerging voice because he did not have a transit visa through Europe.

We felt there were many long presentations that left very little room for discussion, debate, and exchanges of experience.

If there was one good thing about Millenium Development Goals, it was their simplicity. Even a child could understand them. Although health systems researchers are keen on complex adaptive systems, we hope that the forceful message of universal health coverage (UHC) won’t be mired with too much complexity. We talked a lot about systems, yet during the sessions, we remained in our silos.

We missed the discourse on global health governance, on the need for new global arrangements to ensure that we attain UHC everywhere and everyone. We recognise that UHC requires a leap of faith. We feel that while we stand on the rigor of our methodology, we should move beyond our comfortable scientific space and also take up the discourse of UHC in the social and political spaces. Researchers may not be the best activists, but activism will put moral imperative to our research.

Kopano Mabaso, department of public health, University of Oxford, United Kingdom
I wasn’t in Montreux in 2010. I was in South Africa, probably on call, in casualty, looking for gloves. But I did hear about the first global symposium on health systems research. I heard that it was great, I heard that Universal Health Coverage were the words on everyone’s lips, and that health systems the world over were being gearing up towards this new universal goal.

As I excitedly prepared and submitted my abstract for the 2012 conference, there were some who warned that UHC was just another fashion. Perhaps, I thought. But then again, we’ve seen worse fashions. And if striving towards achieving equitable access to healthcare for all and financial risk protection for all is fashionable, well, it’s not a bad fashion to have.

I’ll admit that I too had to confront my moments of doubt. I wondered whether it will work and whether our communities will thank us if we continue to make promises to them we can’t or don’t keep. And at times it does seem that the only thing universal about many of our world’s health systems is their injustice, and that coverage only refers to the thick blanket of disillusionment that smothers many of us.

So I was a little nervous going to Beijing, afraid that the critics were right. But my anxiety was soon assuaged by the three weeks spent with some of our world’s most inspiring young researchers, who recognize that the world has changed, that the poles of power have shifted, and that emerging economies, like emerging voices, are challenging traditional perspectives. If there ever were a time to insist on a better world for us all, it is now.

We follow examples of Kadidiatou Kadio from Burkina Faso who is ensuring that the poor and marginalized be given an opportunity to speak for themselves, Radhika Arora from India who is using innovative mediums to bring together repositories of knowledge, Daniel Henao from Colombia who is unafraid to speak truth to power, Woldekidan Amde from Ethiopia who is helping build capacity of academic institutions to ensure that we have adequate, home grown, expertise.

So as you read this, fear not, for there are emerging voices everywhere, in all corners of the world, as long as you continue to encourage them, support them, enable them, collaborate with them, and make space for them, then, I think we may just reach universal health coverage sooner than we think.

The authors are part of the “Emerging Voices for Global Health” programme of the Institute of Tropical Medicine, Antwerp, Belgium (http://www.ev4gh.net). Run concurrently and in collaboration with the Global Symposium on Health Systems Research, the programme provides training, mentoring and networking opportunities for promising young health researchers and professionals from low and middle income countries.