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Health: Translating fab analysis into meaningful results

It’s the first day at the First Global Symposium on Health Systems Research. I’ve come here for various reasons: to learn from the latest evidence on health systems strengthening and make sure that our own policy work is informed by the best possible information,  meet the best researchers in this field and make sure that our own policy work is able to bridge the research policy gap.

Indeed, very often, researchers write and discuss their papers between themselves, and their fabulous analysis fails to translate into practice and is not taken up by policy makers.

If we want to help children and their families, it’s important that we don’t fall into this trap and produce work/ papers/ tools that are useful, rather than gathering dust in some basement cupboard.

So, what did I learn today? That indeed our drive to make knowledge easily and readily available in low-income countries is necessary. For example, we will soon launch a policy tool to help make health financing choices easy — or at least to help civil society and health policy makers readily grasp what the current evidence is saying.

This policy tool will be a step in the right direction. I’ve also heard interesting experiences of bridging the policy-research gap from Canada: the government there identifies topics of interest to them and taps into the best brains through day-long meetings that are completely confidential.

In this way policymakers are informed by the latest evidence without feeling threatened to be ridiculed if they decide to ignore advice.

I’ve learned about Discrete Choice Experiments (DCE). This is apparently a very trendy and new way of predicting what people will choose to do when faced with various scenari. So for example in health, DCE will predict whether patients will choose a health facility that is an hour away but with grumpy staff, or a health facility that is 3 hours away but staffed with permanently happy individuals.

Potentially useful, but the limitations of the apporach are so many (flaws in underlying economic theory, biases, etc) that I was left wondering why on earth we spent so much energy investing in this approach.

Report consolidates consensus – people shouldn’t pay for healthcare if they’re sick

I also heard what the upcoming World Health Report (WHR) “Health systems financing – the path to universal coverage” will touch upon. The report will highlight the fact that 150 million people in the world suffer financial hardship as a result of illness and that 100 million people are pushed under the poverty line because of out-of-pocket payments (of which user fees are a large part).

It will draw on experiences of countries that have been able to provide protection for their entire population (such as Thailand for example) and offer ideas for low-income countries wishing to move away from user fees. This report will be launched next week in Berlin. I’ll be there, so will let you know what exactly is in it.

What is great about this report is that it will consolidate the now accepted consensus that people should not have to pay when they are sick and that the world needs to move towards other forms of payments that are not attached from the episode of ill health itself (such as national health insurance or tax financed systems).

Caution against results-based health financing

The WHR will also caution against the current enthusiasm for “results-based financing” (RBF) – for example, paying health staff based on their results, i.e. the number of patients they have seen, number of c-sections performed, etc. It will outline that while RBF has shown some impact on providers, it has not shown any impact on health outcomes such as improvements in mortality rates.

Crucially, the literature on RBF does not look into negative impact of the approach, does not measure its cost nor compare it with alternative approaches.

It’s great that the WHO is taking this approach, as RBF is being so heavily pushed by other donors that it has become the new buzz phrase in many policy forums.

Cash transfers: magic new bullets?

The WHR will also caution against Conditional Cash Transfers (CCTs) for similar reasons. Again, great, as these are also becoming extremely trendy for no obvious reason aside from the need to come up with new magic bullets.

On this first day I have also learned about lots of different research initiatives such as REBUILD or CREHS. I hope we can usefully contribute to these and, more importantly, that these projects translate into real improvemets in the lives of children and their families.

Find out more about our work to improve health care systems around the world

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