Reimagining Government episode 3: Health and social care
🎙️ The 3rd episode of #ReimaginingGovernment by @CPI_foundation & @Apoliticalco is live! Listen to @_Rose_Katie @DeidreMulkerin @umdhealthequity @nachiketmor @JantirarA & Michaela Berry share new approaches to health & social care.Share article
🎧 Listen to Ep3 of #ReimaginingGovernment by @CPI_foundation & @Apoliticalco, where changemakers from around the world share how they are transforming health and social care so that people's needs are put first.Share article
"Whilst the challenges that we're working with in the community might have the same name, how we engage with the community and what the response needs to be [is] very contextual, very place-based." @DeidreMulkerin on tailoring for complexity in @QueenslandShare article
🎙️ Reimagining Government
In partnership with Apolitical, this six-part podcast explores radical new approaches to addressing global issues such as the climate crisis, equitable healthcare provision, and rebuilding trust with marginalised communities. By speaking with public servants and politicians at the heart of government, we’ll shine a light on how to reimagine government so it works for everyone.
In the third episode of the ‘Reimagining Government’ podcast, we examine new approaches to health and social care around the world.
The COVID-19 pandemic illustrated the weaknesses of healthcare systems worldwide. And, although the worst of the pandemic seems to have passed in most countries, its lingering effects are still felt, often with ordinary citizens bearing the brunt.
Katie Rose, Director of the Centre for Public Impact in Europe, speaks with changemakers from across the globe who are transforming health and social care to address these issues and improve care for those who need it most.
“We all rely on health and social care at some point in our lives. Everybody gets sick, it's all part of the human experience. But how can we make sure that the system is there to support people when they need it?” - Katie Rose
Their discussion points have been broken down into the following:
00:00 - 04:32 - Introduction to reimagining health and social care
04:33 - 07:20 - The Buurtzorg model and neighbourhood care
07:23 - 11:25 - Michaela Berry on a Blueprint for Children’s Social Care and ‘relationships first’ working
11:26 - 18:08 - Deidre Mulkerin describes how Queensland is delegating authority to First Nations communities
18:10 - 22:21 - Jantirar Abay explains Addis Ababa’s Early Childhood Development Initiative
23:50 - 25:24 - Sharing learning across networks to scale COVID-19 responses
25:25 - 32:36 - Dr. Stephen B. Thomas on building trust with communities to advance health equity
32:42 - 36:16 - Nachiket Mor describes the need to embrace complexity and seek out strengths to improve India’s health systems
36:21 - 38:27 - Conclusion
The Buurtzorg model and neighbourhood care
Buurtzorg translates to ‘neighbourhood care’ and describes a revolutionary method of patient care, focusing on building strong relationships and bespoke healthcare plans tailored to people’s unique needs.
Founded in the Netherlands, Buurtzorg is a healthcare organisation that has taken groundbreaking steps in community care. In the Buurtzorg model, each patient is assigned a team of 12 workers, typically self-managed nurses or social workers, who tailor care to their needs. Strategies of support manifest as a result of the insight gained from the relationships between workers and their patients and the patient’s network of friends and family.
This move away from traditional healthcare approaches has improved the quality of care. For example, in the Netherlands, patient satisfaction scores for those treated using the Buurtzorg model are 30% above the national average. In addition, patients also stay in care for an average of five and a half months, compared to the industry average of seven and a half months.
The Buurtzorg approach teaches us that prioritising relationships can improve public services. How else might it be applied to the health and social care context?
A Blueprint for Children’s Social Care and ‘relationships first’ working
Inspired by the Buurtzorg model, the Centre for Public Impact worked with a range of children’s social workers, supported by Frontline, a UK social work charity, to reimagine how local authorities deliver children’s social care, in a way that prioritises relationships between social workers, children, and their families. Together, they created a blueprint for children’s social care.
One social worker behind the blueprint is Michaela Berry - Service Manager in Children’s Services at an East England local authority. Having witnessed firsthand the administrative challenges social workers face, Berry has been looking at enabling a ‘relationships first’ way of working.
“For me, it's really clear what government could do to help and what measures they could put in place. That would be by asking all levels of management within children's social care right up to the very top in the department for education, any change they make in children's services, how does this facilitate the work of the social worker who's working directly with children and families? [...]” - Michaela Berry
Michaela argues that while system-wide changes are necessary, it is important to focus on the incremental and realistic ones to action real change. Through Crescendo - a social worker-led team dedicated to reimagining the social care system - Michaela is supporting local authorities to do precisely that.
“We build a vision with the frontline of what they would like child services to look like if they were to recreate it. We look then at the barriers that get in the way of living those values right now, and then that's when we kind of figure out what small changes would help us achieve that vision.” - Michaela Berry
The work of Crescendo demonstrates how those on the ground can change health and social care services for the better, but what about action at a state-based level?
Delegated authority to communities
Director General of the Queensland Department of Children, Youth Justice and Multicultural Affairs, Deidre Mulkerin, oversees the welfare of children and young people in Queensland, Australia and its surrounding areas. Deidre explains that in Queensland, it is essential that services are tailored to each place's specific context and need, which varies across the state.
“For Queensland, we have a large urban centre, the capital, and then right across the state to very small remote First Nations communities up in the Cape, and whilst the problems or the challenges that we're working with in the community might have the same headline name such as domestic and family violence, how we engage with the community and what the response needs to be [is] very contextual, very place-based.” - Deidre Mulkerin
For Deidre, it is also important to listen to the voices of the children and young adults being served. Recent developments to the Children Protection Act have set this down in law, requiring children to take part in the decisions about their lives. As such, Queensland has partnered with a children and young people's advocacy body.
The government has formally employed young people to consult on their experiences and run focus groups with other young people to provide a direct source on what they would want their care to look like. Likewise, parents with lived experience of the child protection system have been brought in to consult on early intervention and support services.
Deidre aims to change the future of the Queensland government to one that hands more influence and power over to those directly affected by state decisions through what she calls ‘delegated authority’.
“My hope and my plan is that over the next 5 to 10 years, all of the work that is done for and on behalf of First Nations children, families, and communities is transitioned out of direct government delivery to community-controlled organizations so that communities, traditional learners, elders, are making decisions for on behalf of First Nations children and families.” - Deidre Mulkerin
Addis Ababa’s early childhood support investment
Health and social care services worldwide are seeing a rise in demand.
The challenges of maintaining public services and meeting these demands are often more pressing in areas of rapid population growth. For example, Ethiopia’s capital, Addis Ababa, is predicted to exceed 6.5 million by 2027, with 20% of that number made up of children under 6. Could investing in early childhood development be the key?
Jantirar Abay, Deputy Mayor of the Addis Ababa City Administration, has been overseeing the city’s Early Childhood Development Initiative. The pilot program aims to assist the city's 25% of people living under the poverty line by investing in support at a young age.
“[We are] starting from the parental coaching towards the physical infrastructure down to the ground, especially at the district lab, to make the program sustainable. [...] We also identified the daycare, communal, and the public finance daycare centres. We also give food assistance for [...] pregnant women. These things all have an impact on the development of children.” - Jantirar Abay
Through these initiatives, Addis Ababa is investing in the city’s future, supporting the development of the city’s youth, who will implement change for generations to come.
Scaling COVID-19 responses through learning networks
The COVID-19 pandemic brought with it the most significant global health emergency the world has seen for decades. With it came a myriad of new and immense challenges that called into question the effectiveness of governments at tackling these.
How did government officials collaborate across boundaries to rise to these challenges? One example comes from the Pandemic Solutions Group. Founded in May 2020 by the Rockefeller Foundation, this bipartisan network brought together public officials from across US city, state, country, and tribal nation levels to focus on a dynamic COVID-19 response.
During the pandemic, the group met as a peer network every two weeks to learn about emerging methods and techniques from pioneering practitioners across the country. This drove collaboration around promising initiatives at both the state and local levels.
The group’s work demonstrated a possible future of government - one driven by collaborative learning across networks. By sharing knowledge and resources in relation to testing, tracking, vaccination, and other solutions, the Pandemic Solutions Group enabled public health officials and agencies across the US to rapidly scale COVID-19 responses.
Advancing health equity in the US
But how could government ensure these solutions could reach the most vulnerable parts of society? The pandemic had a disproportionate impact on already marginalised communities and shone a light on the inequities that exist in healthcare access.
Dr. Stephen B. Thomas is a Professor of Health Policy and Management, and Director of the Center for Health Equity, at the University of Maryland. He has been looking at possible interventions to eliminate racial and ethnic disparities in health and healthcare.
“You know, the history of racism and discrimination in the healthcare delivery system would be easy to ignore if it wasn't so well documented. And so when we talk about nurturing relationships with the community, we're really talking about rebuilding trust.” - Dr. Stephen B. Thomas
Dr. Thomas explains that rebuilding this trust had to take place in the shadow of a long history of medical discrimination within BIPOC communities that have fostered attitudes of distrust and apprehension. An infamous example that he cites is the 40-year US Public Health Service Study performed at Tuskegee from 1932 to 1972, that recruited black men to document what would happen if syphilis went untreated.
As a result of this and other historical injustices, many African Americans delay treating new symptoms, sometimes leaving it long enough that medication become less effective.
To tackle the social issues at the root of this medical problem, Dr. Thomas looks at approaches tailored to the communities being served.
“How about meeting people in places that they already have trust? In many black and brown communities, those are non-traditional settings like the black barbershop and beauty salon. [...] Our program is called Health Advocates in Reach and Research where we literally bring medical professionals and public health services into barbershops and salons, and has been hugely, hugely successful.” - Dr. Stephen B. Thomas
The introduction of healthcare services in already trusted areas of the community has helped bridge the gap between citizens and healthcare providers. In addition, the success of the program caught the attention of the press, which in turn caught the attention of The White House.
As a result, the Maryland Center for Health Equity worked with the Biden administration and other partners to roll out ‘Shots at the Shop’. Through this initiative, staff at Black-owned barbershops and hair salons act as health advocates, assisting clients in making informed COVID-related decisions, and hosting COVID-19 vaccination clinics in the shops. This has helped close vaccination and COVID-19-related death gaps between white and black demographics.
Improving India’s health systems
In India, Visiting Scientist at the Banyan Academy of Leadership in Mental Health, Nachiket Mor, has been looking at other ways healthcare systems can innovate and improve. He suggests that India should start with a strengths-based narrative, seeking out the country’s existing strengths and building on them to improve public services.
“I believe there are a number of strengths that we have, for example our very population. Is it possible to imagine an environment in which we are able to recruit local talent, work with them as health aids and community health workers?" - Nachiket Mor
By folding these community members into their support systems as health aids and community health workers, India could integrate those with the most immediate knowledge of what is required, and build on existing infrastructure to strengthen healthcare for all.
As we are learning, reimagining health and social care is not easy. From the Buurtzorg model in the Netherlands, to Queensland’s involvement of children and young people in social services, to the US’s approach to COVID-19 support in African American communities, it is clear that each community comes with its own complex set of barriers and solutions. However, by fostering relationships between government and the people they are serving, we can develop trust and strengthen health and social care services for all.
🎙️ Reimagining Government
This six-part podcast explores radical new approaches to addressing global issues such as the climate crisis, equitable healthcare provision, and rebuilding trust with marginalised communities.
By speaking with public servants and politicians at the heart of government, we’ll shine a light on how to reimagine government so it works for everyone.