SUPPORT-SYSTEMS (30) Reflections on the first week of our discussion (2)

16 May, 2022

Dear Unni,

Thanks very much for this excellent summary. I would like to revisit the question of 'Who' again, because your very nice summary actually made me remember other examples related to the context of Iraq. Recently I have conducted a case study for WHO EMRO and the Alliance for health policy and systems research. The study used the Astana framework for PHC (which includes community response) in relation to COVID-19. I was struck by how much the community itself does which is not made formal and is not recognised either. For example:

- Several make-shift hospitals were built through funds raised by individuals and groups. These people came together in response to the pandemic, collected donations, built a hospital, staffed it with healthcare volunteers and then handed it over to the authorities.

- Individuals and groups of healthcare workers came together to provide services on a voluntary basis.

- Oxygen cylinders were donated

- Some civil society organisations who specialise in other areas, stopped their normal activities and redirected their efforts to the COVID-19 pandemics. For example, the prisoner justice group focused more on preventative measures in prisons, refugee organisations redirected their efforts to santitiation in camps, women groups to gender-based violence as a result of the pandemic....etc.

I guess what I am trying to say here is that we probably need to look into temporary and informal groups that come together for a particular purpose and then dissolve themselves. Also, the 'who' might be fluid and not rigid and change with the evolving context of the country.

It would be useful if studies of civil society and primary healthcare try to capture these activities. We actually found that not including those initiatives in the primary healthcare response, do injustice to a country's response to an emergency such as COVID-19 because we will be only including the response of formal groups or the formal health system.

HIFA profile: Goran Zangana is a medical doctor and Associate Research Fellow with the Middle East Research Institute, Iraq. He is a HIFA country representative for Iraq and is currently based in the UK. He is the current holder of Country Representative of the Year 2021. He is also is a member of the HIFA working group on SUPPORT-SYSTEMS - How can decision-making processes for health systems strengthening and universal health coverage be made more inclusive, responsive and accountable?

goran.zangana AT