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    Putting the power and politics into health systems research: reflections from RinGs

    Health Systems Global has opened a call for ideas on the theme of the 2018 Global Symposium on Health Systems Research, to be held in Liverpool, UK. Recognising this as great opportunity to help shape dialogue and debate on global health over the coming years, the team at RinGs (Research in Gender and Ethics) has been blogging about the need to frame the next symposium around power, politics, equity and rights.

    In this recent blog, RinGs team members Kate Hawkins, Sally Theobald, Rosemary Morgan and Linda Waldman were joined by COMDIS-HSD’s Helen Elsey to offer these key questions to help shape the Liverpool agenda…

    ‘As RinGs is a project that works primarily on gender and ethics, we were delighted that the 2016 Health Systems Global Symposium included a stream on these issues. This meant that gender and ethics were more prominent in 2016 than in previous years. We were also excited by the focus on intersectionality and believe that this is an area that should not be discarded as we move forwards.

    There are several areas where critical reflection is necessary and where we need to begin to try to address persistent and challenging questions:

    Rights and justice

    The right to health is the foundation of health systems strengthening. Key issues and questions include:

    • How has the right to health been actualised in policy, practice and legal challenge?
    • How does the right to health interact with other rights, eg those of women and children?

    Inequity, gender and intersectionality

    Intersecting forms of inequity shape the way that health systems are conceptualised, which issues rise to prominence, and the importance and investment afforded to different challenges. How social stratifiers, such as gender, race, age, class, (dis)ability and/or sexuality, intersect creates different experiences of privilege and disadvantage, leading to vastly different health needs, experiences and outcomes. Key issues and questions include:

    • Social determinants of health continue to drive inequities in health and well-being. How are health systems responding to these up-stream issues?
    • Risk factors driving both communicable and non-communicable diseases are disproportionately experienced by the poorest. How can approaches to prevention respond to intersectionality without stigmatisation?

    Participation and voice

    Participation is a key component of people-centered health systems. If we are going to achieve people-centered health systems, a range of diverse people need a voice and active role in health systems and health systems strengthening. Key issues and questions include:

    • How can community inclusion, involvement and leadership shape health system strengthening?
    • What methodologies have broadened our understandings of people-centred health systems?

     Evidence and information

    Knowledge is power, and information and evidence are not politically neutral building blocks of the health system. Key issues and questions include:

    • In an era where censorship, post-truths and alternative facts increasingly pose a threat to science, how have health systems researchers responded?
    • Why is there so little support for qualitative research in the world of global health and what can we do about this?
    • How can we better ensure that knowledge is communicated beyond the ‘ivory tower’ to the communities, practitioners and policy makers who need it for decision making?

    Money and control

    Those who hold the purse strings can determine how money is spent and who benefits from investments. Key issues and questions include:

    • What are the potential avenues and political roadblocks to ensure financing for Universal Health Coverage?
    • What role is there for public-private partnerships in ensuring that patients are protected and practice is ethical?

    Solidarity and resistance:

    • Can an approach to health systems strengthening build on ‘planetary health’ thinking to prompt new ways of tackling old problems?
    • Many settings are experiencing conflict, economic and environmental instability, and migrant crises leading to the mass movements of people. How can we can ensure that health systems work across borders?

    The 5th Global Symposium on Health Systems Research provides an opportunity for health systems researchers to come together and critically examine the ways in which power and politics shape research and research institutions, and explore how we, as a community, can ensure that good health is attainable for everyone.’