Future Health Systems (FHS) entered its second phase at the end of 2010 with a new six-year, £7.5 million grant from the UK Department for International Development (DFID). In the roughly eight months from the beginning of our inception planning, we find ourselves in a fundamentally different world.
In late January, we saw the Arab Spring blossom across northern Africa and into the Middle East. We’ve seen both Europe and the US locked in a series of debt crises. And we continue to see the emergence of new technologies that are changing lives around the world – sometimes emerging from unexpected places. The locus of global transformation is largely shifting to large middle-income countries like China and India – two countries where FHS has strong institutional partners, CNHDRC in China and IIHMR in India.
During our inception phase, we’ve been seeking to ensure that FHS has a strong foundation to succeed in these shifting sands. At its core, the next phase of FHS will be addressing the question of how we can get new services and technologies out to the most vulnerable in a way that is sustainable and scalable.
We’re excited to be working towards that objective through three cross-cutting themes:
- Unlocking community capabilities – The Arab Spring is a testament to the power of civil society to generate change and hold governments accountable. And while those grand revolutions were happening at the national level, we’ve been witnessing the same power on a smaller scale at the community-level. Community involvement is a core part of health, health promotion, and health service delivery. But often we’ve thought about the role of communities in quite a traditional way – with community health workers or village health committees. The next phase of FHS is interested in thinking more about how we can engage less traditional actors – like informal health care providers, but also those who have resources of one sort or another, whether that’s motorbikes that can help get pregnant women to hospital (like MakSPH have promoted in Eastern Uganda), or whether it’s access to information that can help transfer health knowledge and hold health system actors to account.
- Stimulating innovation – Innovation in health systems takes many forms, from technical innovations – like new products and new vaccines – to organizational innovations and new ways of working. This phase of FHS is interested in understanding how to encourage the uptake of those innovations across health systems. This will involve learning from what’s going on and sharing innovation across innovators about what’s working and what’s not working. Our partner in Bangladesh, ICDDR,B, is on the cutting edge, working with telemedicine centers and other new technologies to extend the reach of formal health services to rural poor.
- Learning by doing – Health systems are complex, dynamic, adaptive systems that change and respond to individual actors and external events. Because of this, we think it’s important to look at how actors within health systems learn, how knowledge spreads across health systems, and how we can adapt our interventions to changing circumstances.
FHS has always been future-oriented – it’s in the name. But before we embark upon this new journey, it’s also important to take stock of the successes of the first phase of the program. I encourage you to look at our stories of success from Uganda and Bangladesh.
One of the things FHS became known for in its first phase was its work on health markets, especially around the role that informal providers play. FHS helped us understand how the likes of rural medical practitioners and drug vendors work and how they engage with the rest of the health care system within a country. Although we’re in a transition phase, this work continues and is clearly represented in some of the recent journal articles produced by FHS researchers, especially in a special supplement to Health Policy and Practice on the private sector in health.
We look forward to building on this strong foundation going forward. When this phase of FHS started, we couldn’t predict the ensuing global changes. And as the program continues, this will continue to be the case. But by building in learning mechanisms and tracking these changes, we’re confident that we will be as relevant in five years as we are today.