Welcome to the Connecting Citizens to Science Podcast.

We are here on the first official day of Health Systems Global a symposium, and on Monday I went

It was really inspiring and it's taken me a couple of days, but now I have the team that worked on that session.

So please introduce yourselves.

Hi, I'm Anuj Kapilashrami, Professor in Global Health Policy and Equity at University of Essex and was

Hello, my name is Neethi Rao.

I'm a consultant and I work with the WHO Health Systems Governance and Financing Unit.

Our focus has been on social participation for UHC and we've had a great time collaborating with the University of Essex and

Hello, my name is Reza Majdzadeh.

I'm senior lecturer at University of Essex in the School of Health and Social Care within the Global Public Health programme.

I have experience of working on the package and community participation both in different

Thank you very much.

It's nice to meet you all.

Tell us a little bit about what the session was called.

What was it about?

It was looking at the effectiveness and sustainability of engaging communities in designing essential services on

The idea being that while community participation is espoused as one of the fundamental principles, values, and now also

The session was really structured around a programme of work that we undertook with WHO EMRO (the Eastern Mediterranean Regional

That's the sort of backdrop to the session.

The session really focused on three areas 00:02:55

the what?

The session really focused on three areas 00:02:59

The why?

The session really focused on three areas 00:03:00

And the how?

The session really focused on three areas 00:03:01

And I will move on to Reza to talk a little bit about the what and the why.

Thank you so much.

Regarding why, we are learning from the success and failures.

We have a huge experience of the failures because of mistrust of people, because of not having them onboard.

At the same time, we have a few examples of successful stories regarding the defining and implementation

This is the reason that we are thinking we should not look at the benefit design package design as the short term

This is the reason that we are thinking how we can make it more sustainable, through participation of the

I think that's great.

In your session, I heard you talk about trust and in nearly all of our episodes of 42 episodes, and

You said failures in trust in this presentation, I remember you saying there's lots of good examples, but also trust doesn't come easy.

Do you have any reflections on that?

Yes, definitely.

You know, this is not something that you can make it in one night.

At the same time, you can break it in one night, because whatever you are building, you can actually destroy it within one event.

Therefore, it is very important to actually to work on collaboration, on partnership and making ownership for people.

At the end of the day, you can make that trust.

It is a long journey, but despite this long journey, you can miss it in just one event, which is very important.

We should take care about successes much more than actually, uh, the failures.

I mean, we should invest more and to make sure that we can succeed this programme.

If we do one mistake, we can loose the actually entire trust that we made.

Trust is very fragile.

That's really interesting.

Neethi from World Health Organisation, how did you find the session?

I saw you asking quite a lot of questions and you received a lot of questions as well.

Do you have any reflections?

I think, fundamentally, what came across really is about policy processes are fundamentally about power differentials

It's also a strategy to build this trust that all talking about over the long term and whether it is priority setting processes or HTA,

Really what we need to build is something that is sustained, moving away from thinking of community

I think that's, for me, the key takeaway from the session.

Thank you very much.

I'm gonna pick up on just one point around power then.

There is inherent power structures that exist within the systems we work in, the health systems we work in, and that did

Do you have any reflections on power in health systems and how communities can be placed more centrally?

Uh, just to say that, uh, in fact from the WHO, we do have some guidance and much more detailed reflections within

Also to say that in fact power is something that we are all familiar with, right?

Within and without health systems just in our everyday life.

It's something that I think, of course all of those imbalances do come in into the policy making spaces as well.

It requires conscious thinking and capacity building, I think, on the part of all of the stakeholders.

To think of ways and strategies, things, for example, within participatory space on mitigating some of these and it requires

One final point I would like to say, particularly when it comes to researchers and academics, such as many who are at this conference,

I think similar consistent effort over the long term also needs to be turned towards how do we as researchers and

I think that's an ongoing project that we are only just about embarking on now and hopefully this

The post Covid journey, especially.

Of course, of course.

And you have something to add here?

Just to add, I mean, I, I think the power question that you're raising is really crucial, and that emerged

Health systems essentially are social institutions and hierarchical social institutions.

They reflect the power asymmetries that we see in the society, and that actually drove us to also look at the

When we talk about engaging communities, who are the communities that are being engaged, and the mechanisms that exist in place

I think that's one of the biggest lesson in the discussion of how we really, even in assessing and evaluating these

I know learning health systems has been a running thread of a number of different sessions, but as we carry on this work and

One of the fundamental challenges will be the changing geopolitical climate, the bigger sort of threats that we experience, which are

So how do you reach out to the most vulnerable group?

Hence the whole lens of power and political determinants in this work becomes quite central.

Thank you very much, and one of the other things that I took away from your session is that there's a lot

Are they people that are already in power within communities?

Are they gatekeepers that could potentially silence other voices?

I know you said the evidence out there of who are on these committees from a demographics point of view needs to be explored more.

Is that correct?

Absolutely.

I think, really first and foremost there is a gap in evidence.

We are not documenting what is happening.

So that does not necessarily mean that these initiatives are not being developed, that communities are not being engaged.

I think, researchers and academics are lagging behind in actually studying these processes, so an important aspect is how research can

The idea that the action domains that have been identified, the values that have been identified, in the operational guidance allows us

That then takes us to questions as are communities just being seen as source of evidence?

Collecting data?

Or are they also being engaged in dialogic processes to review and assess what services exist whether those need to

Finally, their active engagement in advocacy around and reflecting on how these participatory processes

Lovely.

What next, Reza, what next?

What a great session that was and I'm really glad we got a, a chance to catch up on the key points there, but what next?

Okay.

I want to say that we know that we need community participation.

We know the importance of that.

We know many things about theoretical aspects of that, but look at the realities at the ground level.

We know that colleagues in WHO actually prepared this nice handbook about community mobilisation for UHC,

This is the reason that we came up with the idea of implementation of this way of thinking on the benefit package design, which is one of

I want to say that through recent review that, group of colleagues have been doing in six countries, let's say

This is one issue, and if you look at the other country's experiences, the practice in these countries are different from each other.

Therefore, this guide is aligned with the handbook of the WHO and they are actually, uh, supporting each other.

I mean, this is the, lets say, translation of the handbook at the level of the benefit package design, and it is ready,

The purpose of this session was that first, consolidation between different stakeholders, in particular World Health

No doubt we will learn much more when we are implementing this at the field level.

I'm very happy that the result of this discussion was make us more closer to reality of implementation.

On the next steps, on behalf of WHO, just to share the things that are ongoing in this area is one, as Reza already mentioned,

We are also working with each of the WHO two regions, EMRO as Reza already mentioned, but also

As well as at the global level, there is advocacy and movement towards world health resolution, hopefully in a couple

Finally on the capacities aspect, we are also working on developing an online course, an e-course on social participation,

This is exciting times.

Final reflections, advice for others that really want to focus on community participation as much as you have in this session.

I think firstly, I was really delighted at how this whole session panned out and, despite the jet lags, et cetera, on day

I think that really made, it a fairly sort of coherent and comprehensive, but it isn't, this is only the first stage.

It's a starting point and we hope a follow up would also then have community voices heard in these sessions.

We are very, at a very early stage.

We would like to follow up this session with a session where we can also, um, have and hear the experiences of

That, uh, to, to me would be an area.

The other, I would of course welcome researchers, but also other stakeholders to get in touch.

There's just a lot more need that needs to happen, both in terms of studying these, but also in operationalising the

For us, that would be the the necessary next stage of how we can pilot this in countries and learn from it and

Thank you so much, taking me through this journey.

Final comment,

Just I want to say that I want to acknowledge all colleagues that contributed in this session in particular, I want to

First of all, I want to acknowledge World Health Organisation which contributed in this session and in particular Eastern

Then we had a very impressive presence of colleagues from Zanzibar, from Thailand, from Sudan, as well as the regional

Wonderful session.

I really enjoyed it, and now our listeners can access it for a longer period of time.

So thank you very much for joining us in the Connecting Citizens to Science podcast.

Bye-bye.