I’ve been following the tragedy happening in the North West province, regarding the collapse of the health services due to the community and trade union protests. Health systems are the stage where the impact of corruption and bad leadership plays out very dramatically, because they cost people’s lives. What was a trade union-led slow-down of health services in the province has escalated to full-on community strikes that shut down roads and health facilities.
North West hits close to home because it is the focus of my research. I am investigating how we can measure all the elements that come together to improve maternal health outcomes, including community factors. Although I love evidence and metrics, they always show you the picture in retrospect. They show you something that has already happened. They can help model future trajectories for sure, but those depend on certain conditions that in turn depend on the whims of individuals in positions of power. And they can tell you what needs to be done but can’t make people do it. And they are not empowering to the person they are supposed to benefit, the patient. Because measurements don’t equip a patient for dealing with the unexpected challenges that spring up in the public health system.
In this case I use the word “unexpected” very generously. As the reports state, the trouble in the North West has been brewing for years. And it now manifests in a health system where the budget was overspent but few of its targets met. Where prices of medicines are inflated. Where money is divested from hiring more nurses and doctors to fraudulent projects. Where the frustrated reaction of health workers that feel powerless leaves patients without medicines and being discharged prematurely from hospital. Clinics closed. Patients stranded. So I may research the effect of lack of services on health trajectories all I want, and sure enough contribute to the “evidence vault”. But I can’t make people not award contracts to their friends, and that makes me angry.
I became a public health researcher to make a difference, but instances like these make you think hard about how to do that. We are all pieces of a puzzle, I understand. But nothing makes you feel more powerless than the self-interested actions of powerful individuals who can adopt or not adopt whatever guideline you come up with. It’s a reminder of just how embedded health systems are in society – and how a researcher therefore has to be embedded in society-wide action in order to make a difference.
So I’ve been looking for the links between my academic research and those people and organisations that play a more active role. I’ve learned about organizations that track stock-outs, that advocate for rural health, that are on the ground now as we speak, monitoring the situation. They are active behind the scenes, working to entrench real change in the health system. Maybe in the next few weeks I will figure out how to align myself with these actors, beyond just a Twitter follow. Maybe the hopelessness will subside.