Emerging Educators in Health Policy and Systems Research: Support, Strengths and Challenges in the Global South

Figure 1: Building HPSR teaching and learning: emerging educators’ challenges, support needs & strategies

Better teaching and learning are central to building the emerging, interdiscplinary field of Health Policy and Systems Research (HPSR). This blog reflects on the personal, institutional, resource and external support needed to enable emerging educators and organisations to advance the teaching and learning agenda and maximise their contribution to building the HPSR-field.

HPSR is an emerging field that seeks to understand how societies organise and improve themselves to achieve collective health goals, and how different actors interact to influence policy outcomes. It is an interdisciplinary field that merges public health and social sciences on the one hand and theory and practice on the other to understand how health systems make sense of and respond to the policies, systems and health determinants surrounding them (see Alliance for Health Policy and Systems Research). HPSR work has increasingly become part of public health and health policy debates, been incorporated into funding calls and requirements, and featured in national- and global-level analyses.

Policymakers, researchers, funders and health practitioners seeking to improve their HPSR capacity are questioning educators’ capacity to provide the necessary training and how the competencies and skills taught can be used to address their work challenges. At the recent 4th Global Symposium on Health Systems Research, improving HPSR teaching and learning was a sub-theme noted as relevant to the development of the field. A CHEPSAA organised session entitled “South-South collaboration in teaching and learning about Health Policy and Systems Research” discussed support for emerging leaders, mentorship, adapting teaching materials to different contexts, and teaching approaches such as changing from classical face-to-face to blended and online learning.

What support do emerging HPSR educators and institutions need?

Reflecting early lessons from the newly-established Centre for Health Systems and Policy Research (CHESPOR) at the Ghana Institute of Management and Public Administration, Founding Director Gina Teddy addressed the plenary on the support required by emerging educators. Launched in September 2015, CHESPOR’s activities have included training and capacity development, for which it adapted CHESPAA’s modules to the Ghanaian context and facilitated short courses in health systems strengthening and health management for 90 mid- to senior-level Ghanaian health professionals, advocates and policymakers. Gina highlighted personal, institutional, resource-based and external support needs.

Personal support relates to how the individual HPSR educator needs specific competencies to support different pedagogies, classroom management and facilitation. HPSR educators need to respond flexibly to learners’ needs and be committed to engaging beyond the classroom. They also need time to manage their commitments and reflect on their practice and progress through formal and informal feedback, as well as support to build their profiles and status gradually. All of this sometimes requires social and emotional support at the personal level.

Institutionally, some of the most important support required by emerging educators include organisational buy-in and committed resources. Emerging educators also require support with institutional knowledge, an understanding of institutional politics, as well as an appreciation of their institutional roles. This helps them to strategically balance demands for teaching, training, research, administration, fund generation, mentorship and other functions. Institutional support is required towards research and publication, which can be difficult where the institutional affiliation is not traditionally public health.

Emerging HPSR educators and institutions also require support to access operational and research funding organisationally, nationally and internationally. Furthermore, key institutional support resources include a steady source of funding, logistical, structural and physical resources, and committed and relevant staff. Access to accreditations are essential for the sustainability of emerging institutions. For emerging educators’ institutions to gain credibility, they should use all opportunities to publicly promote their institutions and functions, for example engaging in advocacy, leading debates on HPSR issues, networking with other sectors, policymakers, and community members, doing research and using research to influence teaching and engagement.

Importantly, emerging educators and institutions require support to be part of a broader network, community of practice and professional association (nationally and globally). They need to develop strong affiliations and relationships with a range of health system actors.

What challenges do emerging HPSR educators and institutions face?

One thread that emerged in the post-plenary group discussions was the challenge of remaining current in an emerging field which is still defining itself. How can emerging educators remain current and improve their skills given the flux in concepts and methods and where seminal texts are still to be written and recommended reading lists are still being compiled? Due to the scarcity of HPSR expertise, many newly-trained educators - still gaining experience - find themselves considered quasi-experts. How can they be mentored and supported as they take on leadership roles in the field?

A second thread focused on how to mainstream a still-emerging field. We explored the challenges of establishing boundaries to define HPSR while growing the field and its reach. Health policy and systems researchers and educators are currently engaged in advocacy in research, higher education and practice settings to make the value of the HPSR approach known. Some contexts are very difficult. One participant raised the sensitivity of dealing with the potentially political nature of HPSR in post-conflict and post-military contexts such as Myanmar. In her experience the critical thinking skills encouraged by HPSR are viewed as subversive. She expressed the need to "learn to question" and shared the challenges of doing and promoting more applied work; there is a tendency to present HPSR as theory to make it less threatening in institutions. Institutions have to negotiate their own political space to begin offering analyses which critique the status quo. However, there are already challenges in accrediting HPSR as part of the curriculum in some institutions such as nursing schools.

A third thread covered the HPSR education agenda which, in countries such as India, has been driven by donor support. Participants in introductory courses are often unaware of the field, but have been sponsored to attend training. Many are pleasantly surprised by the approach and are then eager to learn more, but the lack of intrinsic demand is challenging. It leads to questions about who the participants are and how to meet their needs? Do we adapt courses for the participants, or do we need to more deliberately set selection criteria in line with our objectives and approach? This also requires advocacy and a communication strategy.

A final discussion thread reflected on the experience in India, where the development of HPSR courses and materials has been largely based on volunteerism, with educators wanting to promote and make accessible the orientation and skill-set offered by HPSR. Accordingly, they have sought out opportunities to develop curricula and collaborate with other institutions, over and above their already full work schedules. While this passion is laudable, it is not a sustainable model for growing the field. There needs to be more systematic investment in building an adequately funded infrastructure and pool of skilled educators.

Strategies
The workshop participants identified a number of strategies to support emerging educators. One important foundation of support would be to have a platform for educators across the South to share experience in adapting materials to their contexts and to provide peer-support and mentoring for new educators. Such a platform would also allow for success to be celebrated, spreading encouragement. As a group we felt that exchanging knowledge about methods and approaches to teaching difficult concepts would allow for learning and growth across contexts. We called for long-term funding to move from volunteerism to sustainable teaching and learning and affirmed that we want to keep open access to the material that we develop to allow for sharing, solidarity and collaboration. Finally, there is a need to rapidly build a cadre of mentors to support emerging educators, and perhaps a set of mentors for the mentors who may themselves still be fairly new in the field.

Vera Scott, University of the Western Cape; Gina Teddy, Centre for Health Systems and Policy Research; Surekha Garimella, Public Health Foundation of India