Lessons in Optimism: How a Two-Week Course Changed My Thinking on Health Systems Strengthening

Excited to attend a two-week course on Strengthening Human Resources for Health at the Harvard School of Public Health, I checked into my hotel in Boston on a Sunday evening. At the front desk, I received my room key and the largest binder I’ve ever seen. I settled into my room and opened the binder expecting to find some overview materials and Boston tourism brochures. Instead it was full of course outlines and required articles.

Information overload
My technical expertise is in library and information science within the context of global health, so it’s hard to intimidate me with information overload. But as I began the required readings for the first day of class, pessimism dominated my thoughts due to the reinforcement of something I already knew—addressing human resources for health (HRH) challenges can seem overwhelming.

With so many topics to cover in just two weeks, could this course really make a difference? My mind raced as I read about many different frameworks for examining health system components. Who could possibly have expertise in all these areas (i.e., finance, labor markets, policy, management, leadership) as well as public health? 

You need to know what you don’t know
Throughout the course, I noticed my initial pessimism slowly turning into optimism. Collectively, the faculty and participants delved deep into the issues, but not too deep. We learned from the experts and each other.  It’s not required that everyone be an expert in finance or labor markets, nor do we all need to be strategic planning gurus or charismatic, take-charge leaders. However, we do need a basic understanding of the interconnected components of health systems, and we need to forge partnerships with the folks who complement our own expertise and styles.

In other words, you need to know what you don’t know, be open to new approaches, and recognize that across the world in both more and less developed countries, we’re facing very similar problems within very different contexts.

Top five lessons learned

1. Respect and use data. Whether you’re advocating for more funds, analyzing an HRH problem, or setting a target, find the best data you can and use it.
   
2. Take time to share what you know. Participants representing locations as different as Pakistan and the Caribbean found that they shared many similar HRH problems.
3. Be innovative. Whether it’s midwives trained to provide cesarean sections in Mozambique or the AIHA Twinning Center in Ethiopia using the Ethiopian Diaspora creatively to address health system needs—think beyond the status quo.  
4. Develop management capacity. Strong management capacity is essential to the success of most initiatives. HR administrators tasked with recruitment, hiring, benefits management, etc. cannot solve HRH crises alone. Strong management capacity is necessary at the federal, district, and facility levels. Furthermore, a good clinician does not necessarily translate into a good manager.
5. Prioritize. If you don’t prioritize, HRH issues are overwhelming. Whether a new initiative is politically feasible, a good bang for its buck, or simply a necessary building block toward other initiatives, plot out what you are going to tackle first and just do it.

Photo: Courtesy of Corinne Farrell