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HSR2022 Special - Conversations in the Halls (Episode 3)

Our team of podcasters are roaming the halls of HSR2022 to bring you the thoughts and takeways of the presenters and delegates after the sessions, with a focus on community engagement.

In today’s special episode (capturing thoughts from 02/11/22) we have:

Dr. Dheepa Rajan - Health Systems Adviser, WHO

Dr. Anne Musuva – Country Director, ThinkWell

Rachael Farquhar – Senior Research Officer, Burnet Institute

More conference coverage coming your way throughout the week!

Follow Connecting Citizens to Science on your usual podcast platform to hear our equitable global health research podcast connect discussing how researchers connect with communities and people to co-develop solutions to global health challenges. The series covers wide ranging topics such as TB, NTD’s, antenatal and postnatal care, mental wellbeing and climate change linked to health.

Transcript
Kim:

Welcome to the Connecting Citizens to Science Podcast.

Kim:

We have a new participant here at Health Systems Global, day three, which is

Kim:

actually kind of day one because the first two were kind of satellite sessions.

Kim:

I'm here with Dheepa Rajan from the World Health Organisation, and we have

Kim:

just been talking about terminology, but let's hear a little bit about who you

Kim:

are, your background and then a bit more about the conversation we were having.

Dheepa:

Thanks Kim.

Dheepa:

Yes, my name is Dheepa and I am with WHO.

Dheepa:

I was with headquarters until very recently, for 16 years.

Dheepa:

Um, and in July I moved to the European regional office, specifically

Dheepa:

a sub office based in Brussels called the European Observatory

Dheepa:

for Health Systems and Policies.

Dheepa:

I've, this past decade or so, I've been working on health systems performance,

Dheepa:

community engagement, primary healthcare.

Kim:

Excellent.

Kim:

The community engagement angle; you were telling me a bit about there's

Kim:

so much different terminology out there that we hear all the time

Kim:

that you had a discussion about what language you would use.

Kim:

Can you talk us through that?

Dheepa:

In the health space, specifically in the programmatic health space,

Dheepa:

when we're looking at malaria programs or HIV programs, often the term that

Dheepa:

is used as community engagement.

Dheepa:

Probably because the focus is on engaging with a certain community such

Dheepa:

as the HIV community or community of people affected by NCDs or whatever.

Dheepa:

So a certain community of people affected by a certain disease

Dheepa:

or who are part of a cohort.

Dheepa:

The term community engagement is quite anchored, I think in the

Dheepa:

global health, public health space.

Dheepa:

We recently put out last year a handbook on social participation

Dheepa:

for universal health coverage.

Dheepa:

In the two years that we spent developing the handbook with an external and

Dheepa:

internal advisory group, we also reviewed the different terminologies used and

Dheepa:

looked at all the different definitions.

Dheepa:

In the end, we kind of landed on social participation because we wanted to make

Dheepa:

the point that this is about engaging with communities, but also with civil

Dheepa:

societies, sometimes as intermediaries and sometimes just the general lay

Dheepa:

public who may or may not be affected directly by a certain health topic.

Dheepa:

We thought that was a bit broader.

Dheepa:

The term social participation is broadly used in the Latin American region.

Dheepa:

In this region of the Americas it seems to be quite anchored in a lot of the

Dheepa:

declarations, frameworks resolutions, a around PHC (primary healthcare) and

Dheepa:

universal health coverage, and the essential health public health functions.

Dheepa:

All of those documents; you'll see the term social participation.

Dheepa:

There are regions within the WHO regional network that prefer the

Dheepa:

term participatory governance.

Dheepa:

It goes back to the fact that governance is something that's seen

Dheepa:

to be largely done by governments.

Dheepa:

Since we're a member state run organisation and we mainly work with

Dheepa:

our member states through governments, through ministries of health, this is

Dheepa:

the term that tends to be preferred, at least in the health systems space.

Dheepa:

When going to the programmatic departments, they often still

Dheepa:

use community engagement.

Dheepa:

There's a large variety of terminology.

Dheepa:

There's a lot that I haven't even mentioned.

Dheepa:

We did a whole overview and review of definitions, which is in the chapter one

Dheepa:

of our handbook on social participation for universal health coverage, but

Dheepa:

these are the three I think, that are most relevant at the moment.

Kim:

That's fantastic.

Kim:

Thank you.

Kim:

There's new terminology there that we don't use so much.

Kim:

It's really good to understand across the world how we use

Kim:

language and what it means as well.

Kim:

Tell us more about the handbook.

Kim:

That sounds very interesting.

Dheepa:

So the handbook we released it last year, 2021, and it was

Dheepa:

preceded by about two years, more or less worth of research.

Dheepa:

It was steered by an external advisory group, which we call the Social

Dheepa:

Participation Technical Network, and then also an internal group of

Dheepa:

W H O experts working in the topic, because as I mentioned previously, a

Dheepa:

lot of the expertise and experience in this realm of community engagement

Dheepa:

comes from the vertical programs.

Dheepa:

We had people in that internal group from the malaria department

Dheepa:

and the HIV department, et cetera, and they have longstanding

Dheepa:

experience working with communities.

Dheepa:

Then we did nine case studies where we did primary data collections in nine countries

Dheepa:

in all of the different W H O regions.

Dheepa:

Then we did about 8 literature reviews.

Dheepa:

The point of this handbook was to target policy makers in

Dheepa:

the 'how to' of participation.

Dheepa:

What we see is a huge capacity gap among policy makers, mainly because policy

Dheepa:

makers in the help space tend to have quite a medical technical background.

Dheepa:

This is not something they've been trained to do.

Dheepa:

They haven't been trained to engage with people, they haven't been

Dheepa:

trained to listen to what experiential knowledge and translate that into

Dheepa:

something that's policy relevant.

Dheepa:

That's exactly what this handbook aims to give guidance on and support, you know,

Dheepa:

how do we organise a participatory space?

Dheepa:

How do you think, through whom you invite, what is representation?

Dheepa:

Who represents whom?

Dheepa:

How do you define your policy question that you want to discuss in that space?

Dheepa:

What is the format and design that you use?

Dheepa:

There's so many options; there's citizens juries, free for all open mic

Dheepa:

sessions, there's more deliberative processes like citizen panels.

Dheepa:

There's so many different formats and participatory

Dheepa:

space design that you can use.

Dheepa:

It's a bit mindboggling to figure out which ones you should

Dheepa:

use for which topic and how.

Kim:

The handbook sounds amazing.

Kim:

I also love the fact that you've designed it for policy makers by the sound of it.

Kim:

A year on, you released it last year.

Kim:

What is your feeling?

Kim:

Are policy makers using it?

Kim:

Is it working well?

Dheepa:

We do get quite a few country requests for support where we go in

Dheepa:

and see what the policy process is and see how we can build in participatory

Dheepa:

processes into that process.

Dheepa:

The largest obstacle that we still face in countries is

Dheepa:

political will for participation.

Dheepa:

There's often this vague idea that, okay, we need to do some civil society

Dheepa:

consultation, or we need to bring in communities into this process, and

Dheepa:

that's where we get the requests.

Dheepa:

Then when you actually go into countries, you see reluctance in uncertain aspects

Dheepa:

of the participatory process or people or policy makers realise that it takes

Dheepa:

some time that you have to invest in it, and the process has already started.

Dheepa:

The political will issue is a challenge and that's why one stream

Dheepa:

of work that we're working on is to move towards a World Health Assembly

Dheepa:

resolution in a couple of years.

Dheepa:

We're working now region by to get buy-in from member states for

Dheepa:

regional committee resolutions to then feed into a World Health Assembly

Dheepa:

resolution in a couple of years.

Dheepa:

The point of that is to engage with member states at a higher

Dheepa:

level to get the political will.

Dheepa:

At the same time, we're trying to work with civil society organisations

Dheepa:

also through the UHC 2030 Civil Society Engagement Mechanisms and

Dheepa:

other platforms, because W H O doesn't necessarily have those platforms to

Dheepa:

work directly with civil society.

Dheepa:

We have to work through other platforms to work with civil society to support

Dheepa:

more grassroots type movement so that it's top down and bottom up together.

Dheepa:

Hopefully that will bring about some more political will to actually

Dheepa:

invest in participatory spaces.

Dheepa:

Most countries are okay with the principle of participation and agree

Dheepa:

to it, but when it comes to going from the principle to action, we

Dheepa:

haven't seen so much action on that.

Dheepa:

There's exceptions and there's some good practices here and there a

Dheepa:

lot of ad hoc, um, participatory spaces or processes happening.

Dheepa:

We want to see something more regular, frequent, institutionalised.

Dheepa:

We're not there yet, but I'm sure we'll get there.

Kim:

That sounds really good.

Kim:

It's useful to hear how you're tackling that political agenda in

Kim:

different ways, so that's fantastic.

Kim:

So here at the conference, you've been presenting the handbook, and

Kim:

I've seen you in many sessions.

Kim:

How are the sessions going for you?

Kim:

Are you talking to lots of people?

Kim:

Are the conversations developing?

Dheepa:

It's been, you know, really interesting.

Dheepa:

It's exciting to be here because we haven't seen each other

Dheepa:

in person for a long time.

Dheepa:

So it's great to see a lot of colleagues and people that we've met only like

Dheepa:

during the pandemic online and to see them here and to talk about intensifying

Dheepa:

our collaboration in our common goal.

Dheepa:

There is increasing interest in community engagement and social participation.

Dheepa:

Partly, I think, stimulated through the Covid crisis where that aspect has

Dheepa:

come out as one of the key defining issues of whether the country was

Dheepa:

successful in its covid response.

Dheepa:

It's great to see this topic of community engagement and community connection being

Dheepa:

woven through the different sessions.

Kim:

I've seen many sessions around power as well and participation

Kim:

and really on picking that.

Kim:

I think there's a real thirst for change there.

Kim:

You mentioned case studies right at the beginning in the handbook.

Kim:

Have you used those case studies and are they powerful in creating that

Kim:

political will in different contexts?

Dheepa:

Yes, partly, I mean, especially the best practice case study, some

Dheepa:

of typical best practice examples that countries that are doing this

Dheepa:

quite well, they, we use them to kind of give other countries something

Dheepa:

to orient themselves towards.

Dheepa:

To have that documented in detail exactly how they've done it, how they've put

Dheepa:

their process together, how do they get their funding, how do they, uh,

Dheepa:

do their, select their participants.

Dheepa:

That's been really useful in knowledge sharing and knowledge brokering, and in

Dheepa:

country as well, with these case studies, we've tried to also feedback sessions in

Dheepa:

countries to make sure that the results feed into something at the policy level.

Dheepa:

We finished the case studies around Covid when Covid hit, so we didn't do

Dheepa:

them as intensively as we wanted to because we were all grounded at home.

Dheepa:

Now we're trying to get them out, publish them, have the published piece, be the

Dheepa:

object of a sort of policy dialogue.

Kim:

Last question before I let you get back to the conference.

Kim:

We like to end a piece of advice for people that want to engage communities.

Kim:

What would you give them?

Dheepa:

I think the first thing is to understand who your community is and

Dheepa:

get a sense of who they are by first informally engaging with them to get

Dheepa:

a sense of who they are, what are their issues, what's their language,

Dheepa:

what are their concerns, and bring them on board in that development of

Dheepa:

your community engagement process.

Dheepa:

That's often easier said than done.

Dheepa:

What is, what I found to be quite helpful is that early on, through the informal

Dheepa:

engagement, you can find out fairly easily who your champions are and who your

Dheepa:

intermediaries will be, who has the trust of the communities and that can be sort of

Dheepa:

the person or people or institution that you work with and go via, so to speak.

Kim:

Trust has come up in a lot of our interviews throughout this

Kim:

and also throughout the podcast.

Kim:

Nearly every episode talks about that importance of trust.

Kim:

Thank you so much for joining me today.

Kim:

Enjoy the rest of the conference.

Dheepa:

Thank you very much.

Kim:

Hello, we have a brand new guest today, Anne, on day three at Health

Kim:

Systems Global Symposium conference.

Kim:

Anne, welcome.

Kim:

I hope you're enjoying the conference.

Kim:

How has it been so far?

Anne:

It's been fantastic, having a great time connecting with all

Anne:

friends, but also learning, sharing.

Anne:

Always fun.

Kim:

Tell us, I know that you said that you don't directly engage with

Kim:

communities, but you do want communities to be more engaged in the work you do.

Kim:

Tell us, uh, first of all, who are you, and a bit more about that.

Anne:

Thank you Kim.

Anne:

My name is Anne Musuva I work for an organisation called ThinkWell

Anne:

in Kenya as a county director.

Anne:

ThinkWell is a health systems development organisation that

Anne:

supports countries in their journey towards universal health coverage.

Anne:

One of the projects that we've been implementing in Kenya is about supporting

Anne:

various county governments to better implement the Linda Mama programme.

Anne:

Linda Mama is a free maternity programme that offers free care for mothers

Anne:

at point of use, and so mothers get free maternity services, delivery,

Anne:

antenatal and post-natal services.

Anne:

What we have seen from my evaluation of this programme is that the programme

Anne:

is tending to benefit the wealthier off and those who are more educated.

Anne:

Yet the project is actually designed for the poorest and most vulnerable women.

Anne:

What we've realised in the course of our work is that most vulnerable women do

Anne:

not actually know about the programme.

Anne:

This really speaks to the point of engaging communities as we are designing

Anne:

a really great project from our fancy offices in Nairobi, we really have

Anne:

to think about how we'll actually engage communities to know about the

Anne:

intervention that we've designed for them to get their voice and feedback

Anne:

and to get them to actually benefit from this project that we've thought through.

Kim:

Wonderful.

Kim:

And do you have an idea how you might do that yet, or is it too early?

Anne:

I wouldn't say it's too early.

Anne:

There are many other, there are ways that have been proven out there.

Anne:

So one for example is just use of community health volunteers who are

Anne:

available in our setting in Kenya.

Anne:

They know about the project and I think there's actually an opportunity

Anne:

for them to reach out to the women they interact with on a daily

Anne:

basis within these communities.

Anne:

Community health volunteers map out households within their village and able

Anne:

to tell which woman is pregnant, who needs care and can refer them to the health

Anne:

facility and let them know about this programme that can benefit them so that

Anne:

they do not have to fork out money trying to pay for delivery services and so on.

Kim:

Have they been involved so far at all, or do you think it just needs

Kim:

more involvement from their part?

Anne:

I think it needs more involvement.

Anne:

The engagement of community health volunteers has been limited.

Anne:

This programme has been focused a lot, I would say, at facility

Anne:

level and at county level.

Anne:

In our experience, even with the public facilities, some public facilities

Anne:

do not even have much awareness about the Linda Mama programme, for

Anne:

example, what benefits are there?

Anne:

How much funds should they be claiming for reimbursement from the

Anne:

National Health Insurance Program?

Anne:

I think generally there's a lot of room for communication about

Anne:

the program, both at facility level, but also at community level.

Kim:

Wonderful.

Kim:

Thank you very much.

Kim:

I know you wanna go to your next session.

Kim:

What are you going to next?

Anne:

I'm going to a session on corruption and how to deal with corruption.

Anne:

That's one of the main problems that we have on the continent.

Kim:

Well, I won't keep you very much longer.

Kim:

Thank you very much.

Kim:

Have a great conference.

Anne:

Thank you.

Anne:

Bye-Bye.

Bea:

Hello.

Bea:

It's day three of the HSR Conference here in Bogota, and I'm here with

Bea:

Rachel Farquhar who's going to be telling us about her work in

Bea:

Papua New Guinea, and also her reflections on the conference so far.

Bea:

Hi Rachel, and thanks for joining us today.

Rachael:

Thanks for having me.

Rachael:

It's good to be here.

Bea:

Thank you.

Bea:

Please, can you tell us a bit about the work that you do and your role?

Rachael:

I am one of the partnership managers on the STRIVE PNG programme,

Rachael:

which is a vector borne disease surveillance programme in Papa New Guinea.

Rachael:

It brings together researchers, implementers, government partners from

Rachael:

across um, 13 different organisations.

Rachael:

We've adopted an explicit partnership based approach, which has got shared

Rachael:

design as well as guiding principles and coordination of all of the

Rachael:

activities, that are rolled out in PNG, and we work really closely with

Rachael:

a neutral partnership broker, Annie Dori, who's based in Papa New Guinea.

Rachael:

My role is really, supporting the partnership, but then also

Rachael:

undertaking some of the health systems research there with another

Rachael:

colleague of mine, Zebedee Kerry at the Institute of Medical Research.

Rachael:

Super interesting.

Rachael:

I think this is a really great model for partnerships and it's

Rachael:

really inspiring work that you do.

Rachael:

Can you tell us about what your role is like?

Rachael:

Any challenges that you face?

Rachael:

What your day-to-day looks like.

Rachael:

The role, it's quite different on a day-to-day basis, working in a

Rachael:

big partnership like that, there's things pop up and change all the time.

Rachael:

I think what's interesting about working in a cross-cultural partnership as

Rachael:

well is the diversity and perspectives that are brought to the table.

Rachael:

I think a lot of my role is supporting partners to find common ground, but also

Rachael:

enabling them to be able to transform an idea in a way that really brings people's

Rachael:

strengths to the table and also shares the resources across the partnership

Rachael:

where you've got organisations that all have their own unique strengths and

Rachael:

expertise, and it's just really about how we navigate that and how we make

Rachael:

the most of it to ultimately generate more impact and have a better outcome.

Rachael:

I think it's both interesting and complex and difficult at times as well.

Rachael:

I think definitely with not only the amount of people that are

Rachael:

involved that all come from really different backgrounds, but just

Rachael:

the kind of different skill sets that are at the table as well.

Rachael:

We experience challenges in finding that common voice, but also there's

Rachael:

power in differentials between Australia and Papa New Guinea.

Rachael:

There's complex health systems challenges that we work with and these all are able

Rachael:

to be overcome because of the partnership, but it's also something that really needs

Rachael:

to be invested in to make the project work and have sustainable outcomes.

Bea:

Absolutely.

Bea:

That's really, really a great insight into yeah, the realities of working with

Bea:

such big cross-cultural partnership.

Bea:

Thank you for that.

Bea:

I know that you also do some work that's more directly engaging with

Bea:

communities, so I wondered if you could tell us a bit about that as well.

Rachael:

One of the other projects that we're involved in is called

Rachael:

NATNAT and so in PNG in Tok Pisin, NATNAT stands for mosquito, but it's

Rachael:

also a nice long acronym for Newly Adapted Tools and Network Against

Rachael:

Mosquito Borne Disease Transmission.

Rachael:

I think I got it.

Rachael:

What we're doing under the NATNAT study is trialling new vector control tools

Rachael:

that complement the existing tools in PNG, which is long lasting insecticide

Rachael:

nets, and field testing them in four communities across the north coast of

Rachael:

Papa New Guinea, in Madang Province.

Rachael:

I think with any new tool, one of the big parts of that is understanding

Rachael:

what the acceptability and feasibility will be like within a community.

Rachael:

I think one of the clear things that's come through is the importance of

Rachael:

really staggered community engagement at different points of time.

Rachael:

Also just the importance of longstanding historical relationships

Rachael:

with the community through trusted members of their societies.

Rachael:

We work really closely with the Institute of Medical Research, who lead the

Rachael:

implementation of this work, and their ongoing relationships with all of these

Rachael:

four communities for decades now has meant that there's a solid foundation of trust.

Rachael:

As with any new tool or any new intervention that's brought into a place,

Rachael:

it's about really spending the time and investing in the time to make communities

Rachael:

feel well informed and provide an opportunity for them to ask any questions.

Rachael:

I think it's just important to have a strategy that doesn't

Rachael:

mean anyone's left out.

Rachael:

We did massive surveys or group meetings, then we also did multimedia things where

Rachael:

we've got flip charts or a video session.

Rachael:

I think, you know, having these at different points of the day as

Rachael:

well, where some people might be out working in the middle of the

Rachael:

day and available at night time.

Bea:

I think that's a really, really great point.

Bea:

We've heard a lot about relationship building and the importance of

Bea:

trust and sustaining relationships in our other podcasts, so I think

Bea:

you've really echoed that nicely.

Bea:

As a final question, how are you finding the conference?

Bea:

Are there any really interesting talks you've been to or any sort of takeaway

Bea:

messages you have at this point?

Rachael:

I'm loving the conference.

Rachael:

It's been really interesting.

Rachael:

The first three days have been great so far.

Rachael:

One of the things that just keeps on coming up is the importance of

Rachael:

partnerships, but really meaningful partnerships and that in complex health

Rachael:

systems problems, it's not going to be achievable without diversity of

Rachael:

perspectives, skill sets, resources, and just the value add that having

Rachael:

meaningful partnerships brings to any research programme, but particularly

Rachael:

ones that are aimed at health systems strengthening, I think is the take

Rachael:

home message from the last three days.

Bea:

Yeah, completely agree.

Bea:

That's a really great note to finish on.

Bea:

So thank you so much for coming to talk to us and enjoy the rest of the conference.

Rachael:

Thank you.

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Kim Ozano

Research and Development Director at SCL and co-founder and host of the ‘Connecting Citizens to Science’ (CCS) podcast. Kim is a health policy and systems researcher with over 15 years’ experience of designing, delivering and evaluating health and development projects in the Global South and UK. She is an implementation health research specialist, as can be seen from her publications and work at the Liverpool School of Tropical Medicine, where she remains an Honorary lecturer.
Kim creates space in Connecting Citizens to Science for researchers and communities to share their experience of co-production to shape policy and lasting positive change.