Taking a people centred approach to health systems: Insights from my visit to Pretoria University

Reflection by Dr David Nabarro following his visit to the University of Pretoria.

Receiving the invitation from the University of Pretoria to visit the campus and be awarded an honorary doctorate filled me with immense joy. It wasn’t just any invitation, but an opportunity to visit one of the world’s most prestigious universities—a renowned institution with a forward-looking vision, actively tackling the ongoing challenges in South Africa and across Africa.

David Nabarro (third from right) with Vice Chancellor Tawana Kupe (second from left) with Faculty and students. Photo credit: University of Pretoria.

Upon my arrival, I was warmly welcomed by my hosts, the Faculty of Health Sciences. Their impressive standing in academia was evident across the four esteemed schools: medicine, dentistry, healthcare sciences, and health systems and public health. I had the privilege of meeting distinguished deans, engaging in discussions with vice deans and chairs of different schools. These initial interactions affirmed that my visit would be an extraordinary two-day window to learn from an academic community known for its excellence and innovative approach.

During my visit, I explored how this institution effectively engages with diverse entities to foster collaboration and create meaningful impact. This university functions as a vast ecosystem, recognising the importance of the intricate connections that it must establish and nurture with local authorities, government bodies, and stakeholders across various segments of the healthcare system.

Photo credit: University of Pretoria.

Shortly after my arrival on the 11th, I enthusiastically participated in the first of two significant sessions, where I had the privilege of listening to different researchers sharing their work and collaborative efforts. These sessions provided a valuable platform for me to absorb their insights and contribute my own perspectives. The discussions were filled with lively exchanges, extending from noon until 5 p.m. A notable aspect was the informality that fostered the perfect atmosphere for open and engaging dialogue. This kind of setting is something I truly cherish and actively seek during my travels, particularly when I can take the time to embrace and appreciate diverse perspectives.

Given my particular interest, I had the privilege of engaging in organised discussions regarding the spread of zoonotic diseases (those transmitted between humans and animals), as well as the viruses and other agents responsible for infectious diseases and pandemics. Notably, the latter group played a crucial role in characterising the COVID-19 Omicron variant when it first emerged. Additionally, I gained valuable insights into the various strategies employed to control malaria, especially in anticipation of the changing incidence of malaria in Southern Africa due to global warming and climate change.

Photo credit: University of Pretoria.

One aspect that impressed me greatly was the concerted effort to integrate various scientific disciplines and foster interdisciplinary collaboration. This approach ensures that the knowledge generated is directly applicable to the real-world contexts in which people live. For example, the university’s commitment to prioritising the wellbeing and capacities of the people who work in health care, and working with healthcare systems as living systems – influenced, and managed by people – was evident throughout. This reflects the principles of living systems that are so important at 4SD Foundation. The experts in the University understand that achieving equitable public health outcomes, where priority care is available for those who need it, not just those who can afford it, relies on health systems that function well with people’s needs at the centre. In this university the faculty are prepared to think hard about what makes a health system make a difference to the lives and livelihoods of people. They don’t see hospitals as the primary place for improving public health, instead, they recognise the integral role that communities play in health systems.

Overall, my visit to Pretoria university helped me appreciate its dedication to cultivating a holistic and multidimensional approach to research and application. While I realized that I lacked expertise with the local context, I offered some advice on maximising the efficiency of policies and procedures, ensuring optimal resource utilisation, and striving for outcomes that align with the aspirations of the people. A key aspect I emphasised was the importance of recognising the unique identities of different groups and investing in relationships that promote open sharing of ideas and knowledge.

I was able to delve into the five characteristics exhibited by living systems leaders:

1. Hold competing perspectives simultaneously
2. See the whole system differently to its separate parts
3. Feel into the pace, rhythm and readiness
4. See the system in relationship to its environment
5. Meet people right where they really are

These discussions underscored the significance of identity, relationships, and the act of sharing openly — all essential for building long-term, trusting relationships. The exploration of these themes served as a rich source of insights that resonated deeply. It became evident that the principles governing living systems could be harnessed to navigate complex challenges and pursue meaningful change.

Photo credit: University of Pretoria.

One particularly captivating aspect of my visit was witnessing the university’s engagement in the process of reconciliation and forgiveness, as well as observing how the broader society is structured. Through various art forms and exhibits, they vividly portrayed this transformative process. As we collaborated, I realised that there was much to learn from their profound understanding of trust and the characteristics of living systems, which they actively apply in their endeavours.

To conclude the day, we were deeply moved by the inspiring story of Dr. Bongani Mayosi, a brilliant cardiologist who tragically passed away at a young age. Dr. Mayosi had a profound realisation that heart health is profoundly affected by one’s poverty status—a stark reminder that poverty breaks hearts. It reinforced the pressing need to address the profound impact of poverty on individual well-being and overall heart health. It was a poignant moment to be in the presence of Vice Chancellor Tawana Kupe, who had played a pivotal role in developing Dr. Mayosi’s narrative. His involvement highlighted the university’s commitment to recognising and uplifting individuals who embody the values and actions required to drive positive change.

Being immersed in a society actively engaged in the process of reconciliation added another layer of significance to the experience. It underscored the collective effort to heal wounds, reconcile differences, and forge a path towards a more inclusive and harmonious future. Witnessing their willingness to identify role models who exemplify the necessary steps for progress was truly remarkable.

Photo credit: University of Pretoria.

On the final day of my visit, I had the opportunity to explore the Future Africa campus, a hub dedicated to interdisciplinary research on the African continent. I was particularly intrigued by two key initiatives.

• The first centered around understanding the interconnectedness of animal, human, and environmental health—an approach commonly known as “One Health.” I engaged in enlightening discussions with Professor Wanda Makota, delving into the critical relationship between these aspects and the implications for overall well-being.
• The second initiative focused on food systems, and it was truly exciting to witness the enthusiasm and innovative approaches demonstrated by the postdoctoral fellows in their pursuit of interdisciplinary collaboration. We dedicated time to exploring practical ways of making these initiatives a reality, recognising the barriers of the systems in which they work.

Later in the day, I had the privilege of attending the graduation ceremony where I received an honorary doctorate (click here to watch a recording of the event). The atmosphere was vibrant, with academics and the community coming together to celebrate their enormous achievements. The Vice Chancellor delivered a powerful speech, and the Dean shared a statement, emphasising the significance of their milestones. Witnessing the graduates receiving their awards was a moment of shared pride and accomplishment.

As I prepared to depart and return to Geneva, I couldn’t help but reflect on the invaluable lessons I had learned during my time in Pretoria. I was deeply impressed by the country’s resilience in the face of significant ongoing changes and its unwavering commitment to fostering collaboration across different scientific disciplines, sectors, and stakeholders. The collective community’s dedication to driving meaningful change through partnerships was truly inspiring. It became evident that our expertise and experiences held value in supporting activities in Pretoria and other universities. It was a realization that we were not merely observers, but active participants to support the change.

Overall, my visit provided an opportunity to offer capacity-building support, learn from others, and provide valuable feedback. I was honoured to witnessed first-hand the value that academics found in embracing the principles of living systems in their respective journeys. The living systems approach offered a fresh perspective and practical tools that enhanced their work and enriched their academic pursuits and I look forward to accompanying their change.