In 1895, poet Joseph Malins described an ill-starred town shadowed by a cliff. Citizens would regularly tumble off the cliff, so the town mercifully pays for a public ambulance. The poet berates the town for not building a fence at the rim of the cliff. As the G20 come together this July in Hamburg, they should take heed and learn the lessons from this fenceless town. Addressing global health security challenges like pandemics and resistance to antibiotics requires not just an ambulance, but a fence too.
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FHS researcher, David Bishai of the Johns Hopkins Bloomberg School of Public Health, asks “What would it take to make the health systems in Africa ready to snuff out the next Ebola outbreak at the first next case?”
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Health systems researchers face a fork in the road. One path leads to implementation research as big science which can anoint a priestly caste of implementation experts pursuing universal truths and codifying best practices in mistake correction. The experts’ business model is to sell expertise to clients and research foundations. Another path leads to implementation research as small science — a cottage industry practiced by every district health officer, clinic manager, and MoH official.
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This week the world will gather at the 2nd Global Symposium on Health Systems Research in Beijing meeting to collectively forget everything that John Snow stood for. Almost all the programming is about improving the delivery and financing of medical services. Attendees will forget that the best solutions are local solutions based on local data used by local health advocates in harmony with their local community. Few presenters seem to notice that the best and most important part of any health system is not the gleaming hospitals and ICUs. The part that of the health system that creates health changes the social and physical determinants of health through good old fashioned public health practice. Most participants are content to sway to the siren’s song of universal coverage and pretend that doctors are the solution to every malady. The good news is that at least one woman in Beijing remembers John Snow. Dr. Afisah Zakariah is Director of Policy, Planning, Monitoring, and Evaluation for the Ministry of Health in Ghana.
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