Nkem Wellington interviews Peter Hansen

[Editor’s Note:  Peter Hansen, Ph.D., recently joined Results for Development as the director of the Health Systems Strengthening Accelerator, a five-year initiative funded by USAID and the Bill & Melinda Gates Foundation, designed to provide catalytic support to countries as they tackle vexing health systems challenges and accelerate progress toward self-sustaining health systems. In addition to providing executive oversight of the HSS Accelerator, Peter is one of the managing directors of R4D’s health practice and a member of the executive team.

Nkem Wellington, communications director for the Accelerator, recently sat down with him to discuss his interest in health systems and what he’s looking forward to working on over the coming months.]

Nkem: Peter, thanks for joining me for this interview. We’re excited to have you on board at R4D and at the helm of the Health Systems Strengthening Accelerator. To start, can you tell us a little more about your background and how you became interested in public health?

Peter: I have been interested in health, and ideas, for as long as I can remember. It was when I was living in China in my mid-20s that my thinking about the relationship between health and ideas began to crystalize into a specific career path. While studying one of China’s great writers, Lu Xun, I became fascinated by what he described in his book, Nahan, or Call to Arms, as an enlightenment moment in which he concluded that he could have greater impact if he stopped working toward improving people’s health and began rousing people with new ideas to address social and political issues. My own reflection was that health is not only a critical social and political issue, but that it is foundational to everything that individuals and communities experience and achieve. If you help people to lead full and healthy lives, they will make their own choices and fulfill their own potential in their own ways. So, I see work in public health as a way to help people become the best at whatever they want to be. And, by systematically addressing disparities in health outcomes, we can contribute to making society more equitable and just.

Nkem: You’ve had an interesting career — from your post in Afghanistan as the country director for Johns Hopkins School of Public Health, where you worked closely with the Afghanistan Ministry of Public Health, to your time in Geneva with Gavi, the Vaccine Alliance, and the Global Fund to Fight AIDS, Tuberculosis and Malaria. Looking back, is there any one accomplishment you’re most proud of?

Peter: I’ve been very lucky so far in my career to have had opportunities to work with really smart and dedicated people to try to make a difference together. I’ve done my best to combine rigor in methods and a strong focus on data, evidence and measurable outcomes with an approach that places great value on respectful and collaborative working relationships and a commitment to service that places people at the center. I definitely wouldn’t say that I always get this right, but one example of an experience that combined rigorous methods with a human-centered approach was work I did in Afghanistan. Together with a great team, we supported the Ministry of Public Health to significantly enhance its capacity to collect, analyze and use data to exercise effective, data-driven stewardship over the health sector. We could not have done this without a really positive partnership with a wide range of colleagues in the Ministry and beyond, which aimed at serving and supporting them to develop their own systems and capacities. These systems and capacities have continued to grow in ways that contribute directly to a wide range of improved health and social outcomes in Afghanistan, despite the extensive security challenges within the country.

Nkem: That focus on measurable outcomes and collaboration is definitely important for health systems strengthening — which requires a close partnership with governments and local institutions. I’m interested in hearing why you decided to focus on health systems in particular.

Peter: Health systems are critical for generating improved outcomes across a wide range of diseases and conditions and doing so in a sustainable and equitable manner. Thinking back to my anecdote about Lu Xun — his career as a writer and activist was cut short due to tuberculosis, which is the leading infectious cause of death in the world despite now being a preventable and curable disease. This points to the urgent need to address underlying systems issues which keep people from benefitting from preventive and curative interventions known to be effective. A systems approach recognizes the complexity of the challenge and helps grapple with a wide range of issues that need to be addressed. There isn’t a single lever waiting to be pulled somewhere that will fix the issue. A systems approach provides a framework to consider multiple factors simultaneously — and the interplay between them — to determine what actions in a given context will most effectively generate improved outcomes in a sustainable and equitable manner.

Nkem: One of the things that we’re doing on the Accelerator, of course, is thinking about country engagement a little bit differently. Based on your experiences, what have you learned about country engagement? And what, if any, improvements do you think international NGOs could make in this area?

Peter: The principles and approach underpinning country engagement are critical. Older models of development have been more one-sided, with northern institutions often focusing on providing solutions rather than supporting countries to find their own solutions — often on their terms, and reflecting their own perspectives more than those of countries they are supporting. Now, I think the global development community — from multilateral and bilateral institutions, funders and INGOs — is very committed to new models of development that put countries at the center and more effectively support countries to fulfill their own goals and objectives. At R4D, we are aiming to be on the leading edge of this broader movement toward new models. A really good example of that is the Health Systems Strengthening Accelerator, which aims to strengthen countries’ own abilities to drive change to meet today’s needs as well as adaptive challenges that will arise in the future.

Nkem: And what excites you most about that?

Peter: What excites me the most is the chance to contribute to developing a new approach to strengthening health systems, where we’re not starting from specific technical solutions or one specific program or part of the system, but rather putting countries’ own capacities to drive change vis-à-vis their own priorities, systems and processes at the center. One way to think about this is as a move toward a Socratic approach to development, helping countries to strengthen their own capacity to find solutions in a way that is institutionalized within their own context.

Nkem: In your own words, how would you describe the Accelerator and how it supports countries in building stronger, more resilient and responsive health systems?

Peter: The Accelerator aims to help strengthen countries’ own capacities to address adaptive challenges, rather than providing specific technical solutions. It does so through an integrated and iterative approach that recognizes the interdependencies among different parts of the system. It recognizes that addressing one health systems building block at a time won’t help countries make rapid progress in most circumstances, so it’s testing out a more holistic approach for providing support that will help countries achieve self-sustaining health systems faster.

The work will be led by an in-country team of key representatives from government and other key actors with support from local, regional, and global networks of “coaches,” based on whichever mechanism is most suited to a country’s institutional context. The “coaches” will be identified through existing networks such as the Joint Learning Network for Universal Health Coverage, the African Collaborative for Health Financing Solutions, and other relevant channels, with linkages made across initiatives wherever relevant. These coaches have expertise in a variety of areas; for example, in-country research and technical institutions that have expertise related to different health systems challenges — and will focus on supporting knowledge translation and facilitating country teams to learn from each other to identify the right solutions for their context and the pathway to delivering on that change. This would include, for example, facilitating the identification of relevant innovations by countries based on the latest evidence and lessons learned across different settings; the unpacking and translation of the most relevant global knowledge and evidence into action; the integration of adaptive learning approaches to increase the use of evidence and experimentation in health systems design; or the design of strategic communications or change management plans to support the uptake of reforms in a way that suits the institutional context.

Additionally, the Accelerator aims to strengthen the measurement of progress toward health systems strengthening at multiple levels. It’s going to be an exciting journey, with lots of learning and adaptation along the way.

Nkem: Thank you again for taking the time to share some of your thoughts on health systems strengthening and what excites you about the work ahead.

Photo © Results for Development/Bianca Nelson

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