Inspired by the power of networks to strengthen capacity in health systems research, colleagues at Johns Hopkins Bloomberg School of Public Health convened a panel titled “The network approach to strengthening health systems research capacity: experiences from the Global South” for the Global Forum for Health Research (Forum 2015) held in Manila, Philippines from 24-27 August. Four networks engaged in capacity building for health policy and systems research (HPSR) were showcased. Here are the reflections of the Chair (NJ) and the panelists (CM, EE, RR and SG).
By Nasreen Jessani, Chrispus Mayora, Ermin Erasmus, Rosanna Rörström and Surekha Garimella.
Code Blue! Code Blue!
While you must be wondering what we allude to, it’s neither a hospital emergency code, nor the late ‘70s band from the UK. It was the code assigned to our panel – the color dedicated to sessions falling under the conference track “country-led capacity strengthening for health research and innovation.”
What was immediately striking was that amongst all other blue coded sessions, “The network approach to strengthening health systems research capacity: experiences from the Global South” was rather unique in that it highlighted innovations in research capacity strengthening in contrast to the majority, which highlighted capacity strengthening in research and innovation. A subtle but important point with respect not the intentions and approach of an initiative. However, clearly the two are not mutually exclusive.
Understanding this subtleties and the context-specific nature of local and/or regional networks was a key aspect of the convened panel, which consisted of:
- Future Health Systems Africa Hub (FHS Africa Hub): a regional network of 7 East and Central African Schools of Public Health (SPHs)
- The Consortium for Health Policy and Systems Analysis in Africa (CHEPSAA): a regional network of 7 East, West and Southern African universities and 4 European SPHs
- The African/Asian Regional Capacity Development project (ARCADE): a multi-regional network of 16 partnering institutions across Europe, Asia and Africa to deliver online and blended pedagogical approaches to learning HPSR
- KEYSTONE: a national network of HPSR researchers from 15 organizations in India focused on individual and organizational HPSR capacity strengthening.
The hot seat
In order to keep the session interesting for the audience as well as provide boundaries for panelist responses, the chair employed a non-conventional “talk show” format (in contrast to individual presentations) whereby relevant questions about key aspects of the networks were directed at the panelists. In some cases, the questions were relevant to all (eg: governance mechanisms) and in others quite specific (eg: power dynamics between Northern and Southern network partners).
Governance processes guided by partner attributes, core network values
The variety of regions in which these networks operate provided for interesting insights with respect to capacity strengthening priorities as well as baseline capacities of network members and how those shape network traction, action, reaction. Furthermore, the distribution of the networks also determined the governance structures that were adopted with each highlighting its own processes and challenges. Although CHEPSAA and FHS Africa Hub had formal secretariats for communication and coordination, it was interesting to note KEYSTONE’s modus operandi where the network is voluntary but the secretariat is a formal one.
Lost opportunity for cross-network learning
Given that all these networks have the same end goal in mind, there was a sense that more collaboration and cross-learning over the past few years would have been welcome and appreciated. For instance, FHS Africa Hub and CHEPSAA began with capacity assessments in each of the partner institutions as a baseline for identifying priorities for capacity strengthening – both at the same time, in the same region, with the same intent – but without knowing about each other until almost into their 4th year of existence – at which point several experiences were shared. Furthermore, each has designed new modules for HPSR curricula to meet some of the identified capacity gaps and perhaps could have worked together on these. On the other hand, CHEPSAA’s open source materials as well as capacity development activities led to KEYSTONE’s deliberate use and adoption of content for the courses delivered in India. A great example of redundancy reduction, knowledge normalization, and content adaptation and enhancement. ARCADE also subscribes to open source values. Of course multi-network interactions while desirable come with their own set of complexities with respect to the involvement of more stakeholders, timing, funding agreements etc.
The advantages of a network approach to capacity strengthening
Although the format of the panel was designed to allow for discussion rather than presentation, the similarities across the networks at times overshadowed opportunity to discuss differences (and perhaps a lesson learned on more effective means of moderating “talk shows”). For instance it was striking how the emphasis on curriculum development dominated the “achievements” across the panel to the detriment of discussions regarding the nature and type of training, mainstreaming of the training, the standardization across the network, and the tailoring by partners within the network for their local contexts. Although, curiosities about other capacity building achievements received little “airtime,” CHEPSAA highlighted other achievements in areas of capacity strengthening such as how to conduct an organizational capacity assessment, stimulating discussions on the nature and boundaries of HPSR, nesting an emerging leaders program within the larger initiative, focusing on other skills important to the professional workplace such as listening skills, communication, managing meetings etc.
One strategy, two goals
Recognizing that educators in universities are generally hired for their research prowess with little or no training in teaching, CHEPSAA as well as ARCADE colleagues highlighted a strong argument for strengthening not only curriculum content but also curriculum delivery. Pedagogical innovations across network organisations contributed to the design of new and revised online courses, case studies, scenarios, simulations etc to create a more engaged learning environment – an effort that benefitted from co-learning, co-creation, and co-adaptation across network partners. In addition, CHEPSAA deliberately included training of HPSR researchers in curriculum development and delivery with the assumption that many next-generation researchers will eventually become educators.
Network management challenges The logistical, communication and financial challenges of convening partners across the network for decision-making as well as for capacity strengthening initiatives were ubiquitous – much to the relief of the panelists! While they felt that clearly their challenges were not unique, it did raise questions about how communication and leadership can be effectively distributed across dynamic and geographically disperse networks such as these. What was surprisingly positive with respect to power dynamics however was the role of Northern partners in these networks. It appeared that in all cases, partners had each brought their own strengths to bear on the network and therefore each had a distinctive place and part in their contributions. Historically entrenched power differentials seemed to have dissipated – at least in these examples. Unfortunately we didn't have enough time to dig deeper into this aspect. Donors for the most part engaged only at times of reporting.
The role of donors
But this brings the issue of donors starkly on the table. What role can donors play in sharing their initiatives with each other and how can synergies between these be facilitated? Furthermore, at the end of these 5-year cycles, the lack of sustained funding subjects these initiatives to a perilous death just at they have gained momentum. While many of the capacity strengthening activities have of course gone beyond individuals to the organizations and networks to which they belong, sustained capacity strengthening is required for institutionalization of values, processes and skills. The lack of sustained funding and transition processes subject donor investment to fewer dividends than possible.
People, power, politics and more…
The panelists had enthusiastically planned to engage in discussions on aspects of donor relations, the role of Northern vs Southern partners, trickle-down effects, implementation challenges, balancing priorities of partners versus network as a whole, power relations, distributive leadership, network evaluation and much more. Unfortunately time sped by leaving little time to explore all the exciting aspects of using a network approach to capacity strengthening. We have therefore decided to find a way to harness all these experiences and lessons in a different format and share it as soon as we can. Stay tuned…for code blue take two!
Authors and panellists
Dr. Nasreen Jessani works in global public health policy and systems based in Johannesburg, South Africa. Her work spans health system strengthening through evidence-informed decision-making. She contributes to FHS Africa Hub as part of Johns Hopkins Bloomberg School of Public Health’s technical support role. In addition she led the external evaluation of CHEPSAA. She is on the advisory board of Academy Health’s Translation and Dissemination Institute and a WHO Foodborne Diseases Burden Epidemiology Reference Group (FERG) task force on knowledge translation and policy. Twitter: @NasreenJessani
Chrispus Mayora is currently a Lecturer in the Department of Health Policy, Planning and Management (HPPM), School of Public Health, Makerere University Uganda. Chrispus is currently the coordinator of the Future Health Systems Africa Hub. He joined the project in 2013 while it was in its 3rd year of programming and has played a critical coordination and management role across the network.
Dr. Surekha Garimella is a senior scientist with the Health Governance Hub at Public Health Foundation of India. She co-coordinated the KEYSTONE Course, which is a key component of the KEYSTONE initiative. She has a multi-disciplinary background and is interest in the software of health systems and what gendered health systems may look like and achieve.
Ermin Erasmus has worked in the field of health policy and systems research (HPSR) for the past 13 years and deeply entrenched in the South African context. Ermin has served as the principal project coordinator of CHEPSAA since its inception 5 years ago. His experience with the network encompasses strategic planning, partner coordination, communication management, and CHEPSAA documentation.
Rosanna Rörström joins us from Karolinska Institute in Sweden where she has been involved with the ARCADE project as a research assistant. Originally engaged with the Africa aspect of ARCADE which ended in May 2015, she is now also involved with ARCADE Asia which ends in November this year after 4 years of programming. Rosanna’s experiences span work with Swedish Ministry for Foreign Affairs, and United Nations Office on Drugs and Crime (UNODC) in South Africa.