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Dr Irene Akua Agyepong
Ghana Health Service (Research and Development Division)
Connection to the Academy: Academy of Medical Sciences & The Lancet International Health Lecturer (2018). Steering committee member for policy work on maternal and newborn survival and stillbirths in sub-Saharan Africa (2019). Policy workshop participant on universal health coverage (2019)
You are not just a public health practitioner, a doctor or a nurse. If you’re not also an advocate, you won’t see change.
In 2018 Dr Agyepong, who helped found Ghana's national health insurance scheme, came to London to deliver the Academy of Medical Sciences & The Lancet International Health Lecture on global health.
What are the key messages of your lecture?
Health reform is almost always political as well as technical, and you need a culture of mutual respect and interdependence. Researchers need to understand the political nature of using evidence, while politicians need to understand the value of high-quality research and allow intellectual independence.
At the global level, sustainable change has to come from within: if capacity is not there then it must be built. It is better to catalyse and support country-driven change, than take over the driving for fast visible results. Change driven globally with no strength from within can be as transient as the morning dew.
The Academy also worked to promote Dr Agyepong's work to a broader audience - her proposals on universal health care were cross-published in The Lancet and our media team connected her to the BBC Focus on Africa team at the BBC World Service.
More recently, Dr Agyepong and the Academy's international team have collaborated to create workshops that can reshape health policy in low and middle-income countries.
The Academy's workshop on maternal and newborn health in 2018 brought together 65 experts from 15 African countries to address what research could help mothers deliver babies safely in sub-Saharan Africa. Currently, half of the worldwide deaths for both mothers and newborns happen in sub-Saharan Africa, despite this region having only 13% of the world’s population. In 2019, Dr Agyepong again collaborated on a workshop around her specialist area of Universal Health Coverage, and in particular how to ensure high quality care and research. This helped spark subsequent further collaborative work around achieving Universal Health Coverage with national medical academies in Nigeria and Argentina.
I liked the diversity of the workshops: both across the global north and global south, but also gender balance, and a mix of seniorities of researchers and academics from all over the world. I thought that was a really great approach to get that kind of diversity of viewpoints: it helps networking, and the peer to peer exchange of knowledge, learning and capacity-building
What difficulties you have faced when trying to change health policy?
Getting ideas implemented by people in power is never easy, and sometimes it has been outright risky. When I am passionate about an issue I can be outspoken and end up treading on people’s toes. People in power are sometimes not comfortable with being challenged, and your advice can even be interpreted as politically motivated opposition. People in power can find it difficult to know what to do with researchers – and journalists or NGOs for that matter – who contradict pet projects or suggest the data does not support their preferred solutions. Sometimes, they can use their power to marginalize such voices so they stop hearing “unpleasant” information.
How can countries ensure healthcare supports everyone?
I think those who design, implement and manage policies must try to understand what it feels like to be an ordinary person, and beyond that, what it feels like to be poor and deprived. The elite need to make a conscious effort to understand the non-elite. Too often, power and position are seen as ends in themselves rather than tools to serve. I think sometimes we forget that the numbers we are talking about in public health are real people, just like any of us.