London School of Hygiene & Tropical Medicine

Politicians have put health systems firmly on the global agenda, committing to achieve universal health coverage. But how well do they, and those who comment on their decisions, really understand health systems? Often viewed mechanistically, as a set of building blocks, it is easy to overlook how they operate through the interaction of large numbers of people, each with their own understanding of their roles, and often face major constraints that must be overcome. In her inaugural lecture, Professor Dina Balabanova will reflect on the concept of health systems as complex human systems, enmeshed within political and social fabrics, and how this way of thinking can be leveraged to achieve the radical transformations that are needed to deliver person-centred care. She will challenge the conceptualisation of health systems as rigid rule-bound bureaucracies that ignores the needs, expectations, and belief systems of those within them, often leading to unintended consequences even from well-intentioned reforms. She will call on us to embrace this ‘messiness’ and informality as we delve deep into what actually happens within health systems.

Dina’s journey spans geographies, cultures, and worldviews. Her life and work have been shaped by major transitions, growing up in Bulgaria, a socialist country, living through the socio-political transition in eastern Europe and the former Soviet Union, and being exhilarated to join a wider Europe. Later transitions involved reorienting health systems to respond to the rising burden of noncommunicable diseases and the drive to strengthen institutions and public services in sub-Saharan Africa and other low- and middle-income countries. She relishes major challenges, from asking how health systems can deliver ‘good health at low cost’ to finding solutions to seemingly intractable problems such as health sector corruption, seizing crises as windows of opportunity for change.

She emphasizes the power of stories and narratives in improving health and social outcomes, reflecting on why it can seem difficult to listen to and learn from service users, their families, communities, and those involved in service delivery and policy design, but will also show why we must. The journeys that people travel in their search for care, including their motivations and choices, can tell us much that we need to know to work with them to make a difference. However, if we truly want to place people at the heart of health systems, we must be willing to confront entrenched power, stigma, and political and structural constraints. Dina’s profound belief is that achieving positive change can only be possible through overcoming isolation, connecting and collaborating across national and cultural boundaries.

Speaker

Professor Dina Balabanova, LSHTM

Event notices

• The lecture will be followed by an in-person drinks reception from 18.15 - 19.15 in G90
• Please note that you can join this event in person or you can join the session remotely
• Please note that the recording link will be listed on this page when available