Four people sat on a stage in discussion

The 3rd Global
Symposium on
Health Systems

Cape Town, South Africa
30 September – 3 October 2014

A panel of people sat on stage in front of a large screen with two people speaking at a podium

Take a look back at HSR2014

Science and practice of people-centered health systems

Executive summary

Cape Town welcomed the world to the Third Global Symposium on Health Systems Research between 30 September and 3 October 2014. One hundred and twenty five countries were represented by almost 2000 participants, who gathered to discuss and debate the science and practice of people-centered health systems. Over the course of the Symposium, which included four plenary sessions, 170 concurrent and satellite sessions, 572 posters and 11 films.

The Symposium convened researchers, policy-makers and implementers from around the world to develop the field of health systems research and unleash their collective capacity to create, share and apply knowledge to strengthen health systems, towards the vision of globally connected health systems research and policy communities that contribute to the attainment of better health, equity and well-being.

The specific objectives of the 3rd Global Symposium were to:

  1. Share cutting-edge research addressing the development of people-centered health systems (including both conceptual work and the findings of primary and secondary research);
  2. Identify and discuss approaches to research addressing this theme and to strengthening the rigor of this research;
  3. Build the capacities of researchers, policy-makers, practitioners, activists and civil society organizations to conduct and use health systems research related to the theme;
  4. Strengthen learning communities and knowledge-translation platforms working, to support people-centered health systems across disciplines, sectors and countries and, particularly, bridging practitioner, activist and researcher communities.

The theme of people-centered health systems is integral to discussions in many different contexts. It embraces a wide range of issues about health, social justice and human rights, as well as about health systems and service delivery. For example, it:

  • Emphasizes the role of social exclusion and inequities as determinants of poor health and encourages active engagement to address them
  • Addresses concern for improving the quality of health care, for example through strategies of service integration, improving access to essential medicines and engaging patients and health workers in collectively ensuring quality and safety
  • Encompasses the rights and needs of people who work in and for the health system in various roles – as carers, health workers, activists, health system decision-makers and researchers
  • Recognizes that people are at the heart of health system complexity, and influence health system performance and health policy change
  • Links to thinking about social empowerment, and how to recognize and actively progress people’s rights to participate in and determine how health systems are organized, resources allocated and services delivered.

The research agenda related to people-centered health systems is as broad as the complex challenges facing health systems. Like all health policy and systems research it is addressed by work that is deliberately inter-disciplinary or that draws on particular disciplinary traditions; and it applies a range of methodological approaches. Particular attention is, nonetheless, given to participatory and action research and evaluation approaches that support health system change, as well as to the contribution of implementation and complexity sciences in understanding how to bring about change.

In addition, research for people-centered health systems pays attention to who sets the research agenda, how the research is conducted and how to ensure that research has impact on people’s lives. Recognizing that researchers have roles in all these processes, it also acknowledges that they are one group among many with a legitimate concern for people-centered health systems. They bring their professional expertise to the challenge of health policy and system development, and work alongside others, engaging across experience and disciplinary boundaries to generate insights and ideas, and to support change within health systems. Thus, taking action to strengthen people-centered health systems requires strategies for developing learning communities and knowledge-translation platforms that bring researchers, activists, health system managers and policy-makers together.


Progress since Beijing

We note the accomplishments of key milestones committed to in Beijing in 2012. Building on the 2012 WHO Strategy for Health Policy and Systems Research, there has been a consolidation and growth of the health systems research community. Health Systems Global now has over 1500 members from more than 90 countries, and the Society has further developed through nine active and engaged thematic working groups, and a renewed board. The 3rd symposium has demonstrated the vibrancy of our community.


The Symposium covered a number of action themes including health systems development, capacity development for research, cutting-edge and innovative research methods, and learning communities and knowledge translation.

Health system development

Informed by discussions and research presented during the meeting, there are a number of important areas for health system development. The focus on people centeredness emphasized the following points in particular:

  • Encourage and enable national governments to own and lead health reforms towards the achievement of universal health coverage
  • Promote a comprehensive financing strategy that underpins a comprehensive set of entitlements
  • Engage multiple constituencies to increase the fiscal space for the health sector
  • Ensure inclusion of the most marginalized and vulnerable, whose needs and rights must be central in a people-centered health system
  • Promote community participation in planning and monitoring health services, to make them more responsive to people’s needs
  • Ensure that research is embedded in programs from the point of design
  • Promote innovative service-delivery models, including the use of technology such as m-health and e-health to ensure quality and continuity of care.

Capacity development for health systems research

  • Acknowledge and applaud the emerging voices and leaders amongst us and recognize the need to continue to strengthen our efforts to nurture the future generations of the health systems community
  • Address inequities in the availability of health systems research training, and deepen and expand efforts to strengthen teaching for health systems development and research.

Research topics and methods

  • Promote understanding of civil society and social movements that support people centeredness
  • Further develop our understanding of health workers, particularly mid-level health workers, their felt experiences and how to empower them to provide people-centered health services
  • Allow the experience of communities and health workers to be heard, through use of innovative research methods that engage and empower communities including participatory action research, photo-voice, simulations and games
  • Understanding scaling-up of health programs in different contexts remains a priority research area

 Knowledge networks and learning

  • Build our communities through bringing together diverse groups including policy-makers, activists, community representatives, managers, researchers and educators
  • Develop skills to communicate about health systems amongst diverse constituencies
  • Journals need to create space for people-centered knowledge and other innovative forms of health systems research
  • Promote learning from implementation and capture tacit knowledge.

These actions have different implications for different actors. We note, in particular that funders need to engage in longer-term funding of research programs and research capacity building, and we encourage them to help reframe research funding models so as to better engage local stakeholders.

This is the first meeting where the Health Systems Global Thematic Working Groups met and began to coalesce into communities. The Thematic Working Groups will help take forward these and other recommendations arising from the symposium.


Vancouver, Canada is eagerly anticipating the arrival of the global health systems community in 2016, for the Fourth Global Symposium on Health Systems Research. There we will evaluate how far the world has progressed towards adopting a people-centered approach to creating sustainable, equitable, responsive health systems for the benefit of all. In the words of one presenter at the 2014 symposium, we are one world, united in a quest for health for all, beyond the borders of politics and economics. We encourage researchers and funders to contribute towards this global vision