Reflections are articles written by members of the 4SD team, the 4SD academy and the wider 4SD network. They reflect the opinions and perspectives of the author as part of their own sense-making efforts towards systems change. If you have been involved with or have been following our work at 4SD and you would like to write a reflection, please reach out to us via the contact form.

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

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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.

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.

pic of david speaking

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
group photo

Photo credit: University of Pretoria.

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.

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.

Student taking a selfie with David Nabarro

Photo credit: University of Pretoria.

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.

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.
david nabarro award

Photo credit: University of Pretoria.

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.

graduation photo with David Nabarro

Photo credit: University of Pretoria.

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.

Collaboration and partnership key to a sustainable future – Ntiokam Divine

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In 2020, two interconnected pandemics claimed global attention. COVID-19 exposed the fragility of our….

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Reflecting on COVID-19 communications

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Karen S. Palmer is a health care systems analyst and policy researcher, an adjunct professor at Simon Fraser University,  and a Senior Research Associate with CanCOVID.ca. She has been joining the COVID-19 Open Online Briefings since early on in the pandemic and has recently launched a Perspectives Brief entitled “How Language Shapes Change: Perspectives on the Most and Least Effective Communication Strategies and Tactics during the COVID-19 Pandemic” Download: English / Français.

It is my nature and training to have a global perspective, but it can be easy to forget that there’s still a pandemic and can even feel isolating, like being among the few wearing a mask at the supermarket nowadays. But, joining 4SD’s Open Online Briefings, I am constantly reminded that we are a global community, that we share values and purpose, that the pandemic is not over, that we can all contribute to the solution, that we can always do better. In writing this new report on COVID communication strategies, I learned that the words we use, and how we communicate with the public to make meaning, really matters. I learned that radical transparency in public communications is critical, and that being honest when we are uncertain helps to build trust and fend off misinformation.

“How Language Shapes Change: Perspectives on the Most and Least Effective Communication Strategies and Tactics during the COVID-19 Pandemic” Download: English / Français.

The Briefings provide a safe space for sharing and they are the only place that I know of where there is real time information from people in-country across different continents – I can have a sense of what is going on that hasn’t been filtered through other kinds of media. How else would I hear the struggles of today from someone in Mozambique, Chile, Nepal, and the UK all in a one-hour session? The unfiltered nature of the Briefings allows me to hear the raw emotion in peoples voices and their concerns about what is really happening on the ground in that moment in their life. It anchors information in a way that we can’t hear otherwise. Issues ranging from long-COVID, to the recent earthquake in Türkiye and Syria, are all summarised delicately by David Nabarro; for me the Briefings are a touchstone.

The sensemaking and reflection which is part of what 4SD promotes, shares much synergy with this new publication, where the story is told by informants from Canada and beyond. I am simply the listener and narrator – the story is what I learned from the informants – all communications scholars and/or practitioners – and I can honestly say, this is one of the most interesting reports I have ever worked on. It provokes questions of  what will we learn, what could we have done better, and – perhaps most important –will we have the insight and courage to reflect on our mistakes and do some things differently going forward?

I hope that something in this report resonates with people who read it, and that something might change their own practice in how they communicate. In this world where we are all connected in one big complex system, and where the pandemic has exemplified our global connection, we must communicate with meaning, within and beyond our local/provincial and national bubbles.

We can all connect and communicate better with one another and be a part of the solution.

—

About this 4SD Reflection

This article is a reflection by Karen S. Palmer, inspired by the 4SD Foundation Open Online Briefings of Dr David Nabarro.

Participants of the 4SD Foundation Open Online Briefings are invited to share their reflections on how they are navigating complexities from their own perspectives. The views and opinions expressed in these reflections do not necessarily reflect the official policy or position of 4SD as an organization or it’s associated personnel. Any content provided by authors are of their opinion and are not intended to malign any religion, ethnic group, club, organization, company, individual or anyone or anything.

Africa: from crisis to opportunity

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Ad Spijkers worked as a representative of the Food and Agriculture Organization of the UN (FAO) in the Democratic Republic of the Congo (DRC), among other places.

Africa: from crisis to opportunity

The picture is grim. Millions of people displaced and driven into poverty by climate change, COVID-19 and international conflict. An escalating food crisis, resulting from crop failures and rising costs of living. Africa has been particularly hard hit by this. Ethiopia, Somalia and eastern DR Congo, among others, are facing major problems. High inflation reduces purchasing power and the family budget in many countries is now largely spent on food and energy. Due to the crisis, fertilizer has become too expensive, so that the extra kilograms of grain that farmers obtained from a kilogram of fertilizer are now lost.

Prolonged drought, heat, excessive floodings and epidemics of pests and diseases complicate food production for the 1.4 billion Africans. Nigeria – Africa’s most populous country – is facing increased insecurity, inflation and job losses. In addition, divergent views within the United Nations and other international forums disrupt the development of the African agri-food systems and undermine food security. These phenomena can fuel inequality, instability and mass migration to Europe.

For these reasons, it remains essential to support in Africa an agricultural policy that deals strategically and responsibly with water, fertilization, crop protection, available labor and sales opportunities. In order to meet increasingly pressing local food needs, above all local insights must be used to bring about a ‘transformation’ of Africa’s agricultural systems. Crucial to this is the sustainable intensification of small-scale agriculture in particular. Local food production (also on a large scale), local processing and shortening Africa’s food chains can significantly reduce the escalating transport costs.

However, technical solutions alone will not turn the tide. Political vision, will and power at all levels of government is needed to face the growing humanitarian crisis. It is also in our interest, the ‘Global North’, to respect and promote Africa’s self-reliance. At the level of the African Union (AU), Africa itself is in charge of agriculture and food supply. Africans are also increasingly taking the lead at national and regional levels on the basis of their own education, knowledge, skills and experience.

We must respect and encourage this ownership, because a paternalistic attitude of the West is no longer appropriate. Western ideas, which are still part of project proposals and conditions, no longer resonate in Africa. In addition, other major powers are now more in charge, leaving the West geopolitically behind.

Due to the colonial past of many member states and the current agricultural policy and the associated protection, the European Union does not always promote African agriculture. If the Netherlands and the EU want to pursue a sincere development policy based on current geopolitical events, they will have to leave the familiar ‘belittling finger’ at home. The free sharing of knowledge and skills, and entering into egalitarian trade relations must be given priority, based on a greater respect for African ownership and leadership.

Europe and other Western powers can help shape agricultural research, education and development with and for Africa. Preferably orchestrated by the African Union and national governments and where necessary with input from multilateral institutions, development banks and universities. The starting point must be the specific needs and potential possibilities of African farmers. Co-financed with proceeds from Africa’s wealth of primary raw materials, the living conditions of the rural population could improve dramatically. Africa is as big as China, India, the United States and most of Europe put together. In Africa food security is synonymous with human security. Investments, are not enough and resources are needed to address the growing humanitarian challenge–where big powers need to work more actively on peace, security, climate change mitigation and biodiversity conservation.

What has succeeded elsewhere in the Global South during the past fifty years must also become a reality in Africa. African ownership, confidence in one’s own abilities, international cooperation and mutual respect are sine qua non. The continent embodies gigantic potential and the political class increasingly has the means to crank up its economic engine. The joint formulation of a ‘Marshall Plan’ for agriculture – the cornerstone of the African economy – offers Europe a golden opportunity to pay off its colonial debt and offer the continent a better future.

This article is a revision of a column which was published in the December 2022 issue of the Dutch magazine Vork (https://www.vork.org). Thanks to Orlando de Ponti, Martin Smith and Kris Wyckhuys.

About this 4SD Reflection

This article is a reflection by Ad Spijkers following the 4SD Foundation Open Online Briefings of Dr David Nabarro.Ad worked as Representative of the Food and Agriculture Organization (FAO) of the United Nations. He is part of a group of Wageningen development veterans with extensive experience in Africa and Asia.

Participants of the 4SD Foundation Open Online Briefings are invited to share their reflections on how they are navigating complexities from their own perspectives. The views and opinions expressed in these reflections do not necessarily reflect the official policy or position of 4SD as an organization or it’s associated personnel. Any content provided by authors are of their opinion and are not intended to malign any religion, ethnic group, club, organization, company, individual or anyone or anything.

The George Institute India Health Accelerator Programme launches a Health Innovation Challenge for COVID-19

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Covid-Care @Home is an innovation challenge by The George Institute India Health Accelerator Programme covering an ideathon and hackathon aimed at developing innovative solutions for managing covid-19 at home with a focus on rural areas.

Call for Innovations under categories

  1. Management of COVID-19 at home and post COVID complications
  2. Ensuring access to essential medical supplies for management of COVID-19
  3. Tools for dissemination of verified information and tackling misinformation
  4. Mental health support for frontline health workers and people affected by COVID-19

Participation Criteria

  • Ideathon is open to school and college students
  • Hackathon is open to both individual innovators and early stage start ups

Submission Open Till 10/06/2021

The winner from each category will be awarded INR 50,000 and will be provided mentorship by leading industry experts as part of the TGI Health Innovation Fellowship

Learn more and apply now!

How it all began

A reflection by Dr Oommen John is a physician researcher and digital health expert. He works at The George Institute for Global Health India and a Professor at Prasanna School of Public Health, Manipal Academy of Higher Education.

In early April 2021, as the number of persons with COVID-19 were rising exponentially in India, the healthcare delivery systems began to crumble. As a health professional, I dreaded every phone call that I would receive during those days, on the other side would be a friend or acquaintance gasping for breath and pleading for help in finding a bed. As the pandemic surged, the frantic calls for help kept increasing beyond my capacity to respond and the guilt growing to the extent of needing to sedate my conscience and switch off the phone.  While you can cut off communications, the subconscious mind keeps processing those faint voices crying for help. As a public health professional I was desperate and looking for oxygen that could make the health systems stay alive, taking to social media to vent the frustration at the lack of systems approaches to addressing public health crisis.

The algorithms read between my words and led me to COVID-19 Open Online Briefings with Dr. David Nabarro hosted by 4SD. It was a transformative experience being part of the discussion led by David, driving home the key message around the pivotal role of systems approach for comprehensive COVID-19 response. I was invited to share my experiences from the ground, which provided an opportunity for experts from other regions to share what worked for them. In summarizing, David drove home the point that the ongoing pandemic is likely to linger for a long time and highlighted the need for systems thinking and whole of government response.

My participation at the Open Online Briefings and guidance provided by David got me thinking on how public health response in India and south east Asia could be augmented and prepared for this long haul.

I was reminded on an earlier instance of a prior humanitarian crisis that followed the massive earthquake in Nepal, where in a very short span of time we were able to develop and deploy an innovative solution to support health professionals who were involved in the relief work. “QuakeCare” was designed as a point of care decision support tool that provides evidence based guidance for triage and management of crush victims and initiate early treatment interventions to prevent complications. Why not a health innovations challenge for COVID-19?

This got us excited at the George Institute India Health Accelerator Programme, we sought input from innovators and start-ups being mentored by us. We also conducted a telephonic survey to understand the unmet needs from healthcare providers, people affected by COVID-19 in regions with limited healthcare delivery capacity in India and south-east Asia region.

While planning for the health innovation challenge, I contacted David and despite his busy engagement as Special Envoy of the World Health Organization (WHO) Director-General on COVID-19 while the world health assembly being in session, I am honoured and overwhelmed at the support and guidance provided by him and the team at 4SD to support the [email protected] Health Innovation Challenge.

About this 4SD Reflection

This article is a reflection by Dr Oommen John following the COVID-19 Open Online Briefings of Dr. David Nabarro. Dr Oommen John is a physician researcher and digital health expert. He works at The George Institute for Global Health India and a Professor at Prasanna School of Public Health, Manipal Academy of Higher Education. He is an elected fellow of the International Academy of Health Science Informatics.

Trained as an internist, he has worked in primary care settings in resource-limited contexts across LMICS and has extensive field level experience in designing, implementing and evaluating innovative solutions and its applicability in health service delivery. He has served with WHO in Immunization Strengthening and Vaccine Delivery, Research and Development at WHO SEARO. At George Institute for global health India, he leads the India Health Accelerator Programme. His research involves evaluating the role of digital health interventions in improving clinical outcomes. He serves on the expert advisory panel for the Market Access Programme of National Health Authority, India.

He is a member of the scientific advisory committee at Foundation for Innovative Diagnostics (FIND), advisory board of Commonwealth Centre for Digital Health. He has contributed to WHO Digital Health Guidelines development group. Follow @Oommen_john and @GeorgeInstIN to keep up-to-date on social media.

Participants of the COVID-19 Open Online Briefings are invited to share their reflections on how they are navigating complexities from their own perspectives. The views and opinions expressed in these reflections are intended to inspire greater systems leadership during the COVID-19 pandemic. They do not necessarily reflect the official policy or position of 4SD as an organisation or it’s associated personnel. Any content provided by authors are of their opinion and are not intended to malign any religion, ethnic group, club, organization, company, individual or anyone or anything.

A systems approach to the pandemic of COVID-19 & obesity

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In 2020, two interconnected pandemics claimed global attention. COVID-19 exposed the fragility of our health care infrastructure. And it brought to the forefront the dire consequences of our inaction to address obesity. Obesity is both a risk factor for severe outcomes of COVID-19, and a consequence of the disease. Now, more than ever, obesity treatment and prevention must be prioritised as a gateway to health; in doing so, the social, economic, environmental, and biological drivers of both obesity and COVID-19 need to inform decision-making processes.

After COVID-19 was declared a public health emergency of international concern, on March 11th, 2020, it soon became clear that people living with obesity were more susceptible to severe SARS Coronavirus 2 (SARS-CoV-2) outcomes. We now know that the risk for hospitalization for people living with obesity is increased by 113%, whilst the risk of death is 48% higher when compared to individuals of normal weight.[i] Adding to growing concerns are the lockdown restrictions and mental health consequences of the pandemic that threaten weight maintenance and weight-loss efforts, with increased levels of physical inactivity worldwide. Obesity is thus considered an effect of the pandemic and cannot be ignored in both developed and developing countries that bear the highest burden of the disease.

We have nine years to meet the UN global development targets, also known as the Sustainable Development Goals(SDGs). We must act swiftly if we are to do so and fix the catastrophically off-track global obesity targets that are further threatened by the COVID-19 pandemic (SDG3.4, SDG3.8, SDG2). Why so? A lack of progress on obesity jeopardizes achievement of the World Health Organization (WHO) Triple Billion Targets that promises 1 billion people living healthier lives.

As an optimist, I do believe that within a crisis, lie seeds of opportunity. There is hope.

But what is the solution?

From the early days of the COVID-19 outbreak in Wuhan, I followed prevalence trends and response priorities. Having finished my MPH two years ago I never imagined living through a pandemic, at least just yet. Dr. David Nabarro’s Open-Online Briefings provided a platform for interactive discussions and a community to grow with. It exposed me to complex systems thinking – a framework to identify and account for interacting influences on COVID-19 and obesity that will be key to progress.

‘Holding the virus at bay requires following the well-established disciplines of disease outbreak control.  There are no shortcuts and no quick fixes. Different systems need to be woven together at a local level and be well supported by both national authorities and international programmes.  There is a need to do it all and do it well.’ Dr. David Nabarro rightfully says.

What is the missing piece of the puzzle? Youth Voices!

Young people have the innate capacity to see the ‘bigger picture’. They can discover complex interdependencies, including the components of a system that may affect and interact with each other. Their critical tendencies can help us identify barriers in implementing policies, including the incentives and stakeholders that need to be brought to the table. Youth have always been at the forefront of movements for justice and social change, including the Black Lives Matter and Climate Justice movement. They have shown their commitment to activities and improving lives for all.

‘Confronting Obesity: co-creating policy with youth’ (CO-CREATE) a project funded by the European Commission works for youth, with youth. By using a systems approach, the project addresses the unresolved challenges around childhood obesity. Just recently, the perceptions of 257 adolescents  (16-18 year old) on the drivers of childhood obesity across Portugal, Poland, Norway, the Netherlands, and the UK were explored.[ii] Collectively youth identified marketing, access to food (both availability and price), stress, anxiety,  depression, and low body positivity as factors contributing to the obesity epidemic. Not only did they identify such factors, but they also used a process of ‘mapping’ to illustrate how they are causally related to each other and obesity (see figure 1).

Figure 1 – Commercial Drivers of Obesity. Eur J Public Health, ckaa251, https://doi.org/10.1093/eurpub/ckaa251

We must listen to, and work with the important but often most neglected population group in obesity and COVID-19 research. It will build capacity and support decision-making on key issues that are ahead of us:

  1. How to re-open schools safely, including the measures that are likely to receive collective support from students.
  2. How to address the mental health crisis coming in COVID’s wake.
  3. How to roll-out COVID-19 vaccination programmes, particularly amongst populations with low acceptability.
  4. How to mitigate and prevent future infectious disease and pandemic outbreaks and the climate change emergency.

We have all lived with COVID-19 for a year now. The virus is here to stay for the foreseeable future. Equally, not one person has been untouched by confinement, and the hardships that the pandemic has given rise to. If not directly, then indirectly due to the lack of support from neighbouring countries during a local emergency. But this makes us powerful!

We are more united than ever, and It is time to take action as a collective. To engage and support one another for equity and justice for the planet. Every Body needs everybody to address obesity & COVID-19, and this includes youth.

Are you struggling to see systems and appreciate them? Dr. David Nabarro provides excellent guidance here. You can also watch the 4SD narrative on COVID-19 and systemic inequality here.

And remember – ‘Great things are not done by impulse, but by a series of small things brought together’.

[i] Popkin, BM, Du, S, Green, WD, et al. Individuals with obesity and COVID‐19: A global perspective on the epidemiology and biological relationships. Obesity Reviews. 2020; 1– 17. 

[ii] Savona, N., Macauley, T., Aguiar, A., Banik, A., Boberska, M., Brock, J., Brown, A., Hayward, J., Holbæk, H., Rito, A., Mendes, S., Vaaheim, F., van Houten, M., Veltkamp, G., Allender, S., Rutter, H. and Knai, C., 2021. Identifying the views of adolescents in five European countries on the drivers of obesity using group model building. European Journal of Public Health,.

About this 4SD Reflection

This article is a reflection by Claudia Batz following the COVID-19 Open Online Briefings of Dr. David Nabarro. Claudia is an emerging public health professional and a youth advocate with 2 years of experience in global and public health, Currently a Policy and Projects Coordinator at the World Obesity Federation and a Core Team Member of Young Leaders for Health.

At WOF, she supports the dissemination, communication, and utilisation of outputs from 2 EU consortium childhood obesity projects (CO-CREATE & STOP), and the development of youth-friendly materials, briefings, and resources to help policymakers and others seeking to implement obesity-related policies in their countries. Her previous role involved supporting the enhancement and delivery of the Strategic Centre for Obesity Professional Education(SCOPE).

Claudia is keen to improve health literacy and strives to elicit and bring the perspectives and skills of young people into the strategic design and delivery of health-related programs and policies through her engagements.

Participants of the COVID-19 Open Online Briefings are invited to share their reflections on how they are navigating complexities from their own perspectives. The views and opinions expressed in these reflections are intended to inspire greater systems leadership during the COVID-19 pandemic. They do not necessarily reflect the official policy or position of 4SD as an organisation or it’s associated personnel. Any content provided by authors are of their opinion and are not intended to malign any religion, ethnic group, club, organization, company, individual or anyone or anything.

Repercussions of the pandemic in the Global South

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I have been participating in some of the recent COVID-19 Open Online Briefings which reinforce my understanding of how the COVID pandemic is far from over and can have further repercussions in the countries in the Global South, especially in Africa. In the Briefings we often talk about the importance of involving community actors and decisions makers in the response. My recent article published as a column in the December 2020 issue of the Dutch magazine ‘Vork’ below dives into these issues.

Concerted efforts are required to mitigate the many consequences brought about by COVID-19. This piece enlightens particularly involving African youth and intellectuals as main drivers of sustainable agricultural transformation based on small-scale farming for poverty reduction, enhanced food and nutrition! security, resulting in “Global Health”.

Equal trade and resilient food systems for Africa – Covid-19 driven shifts

This article was originally published on 18 of December 2020 in Dutch magazine, ’Vork’.

Africa can develop herself

COVID-19 has revealed several cracks in the globe-spanning agri-food system. Lockdowns have restricted trade flows, compromised access to essential inputs such as quality seed and increased vulnerabilities to external shocks. In Africa, this situation has been further exacerbated by the loss of earnings from migrant workers, due to unemployment caused by the COVID-19 pandemic. The loss of these payments, which are often substantially higher than all development assistance budgets together, with the lack of local employment and massive crop losses due to locust attacks, has been a heavy blow.

Over the years, many African countries have minimized the role of local food systems and sustainable family farming. Instead, various nations now deliberately prioritize the export-oriented production of industrial crops, especially as primary raw materials, to then draw upon the resulting foreign currency to meet primary food needs. In such agri-food systems that are geared towards exports and that extensively rely upon extractive farming practices, the steady degradation of natural capital and net outflows of nutrients have brought about a progressive loss of ecological resilience. COVID-19 has painfully revealed the weaknesses of this production model and illuminated how Africa’s farmers are especially vulnerable to the vagaries of the international market. Indeed, multiple facets of today’s farming model increase the risks of food system collapse and full-blown social crises.

Africa should take agricultural development into its own hands

The course of Africa’s food systems needs to be properly charted. Food production in Africa requires investment in technological development, innovation tailored to local (agro-ecological, socio-economic) contexts, and a deliberate focus on smallholder agriculture. If Africa wants to gain a strong position, it must shed its image as a marginal continent where western nations can easily source low-cost primary produce and dump their (subsidized) farm surpluses. One of Africa’s key assets is its young, dynamic and hard-working population, many of whom live outside of urban areas, inhabiting fertile farmland and with boundless natural resources at their fingertips. Hence, Africa’s investments need to be tailored to smallholder family farming and to agri-food systems that are protective of human and environmental health.

It is high time to strengthen Africa’s agricultural and food self-reliance, improve food and nutrition security and mitigate the environmental footprint of agriculture. In addition, well-educated Africans, like the many tens of thousands of agronomists, deserve more respect, better paying jobs and a “hand at the helm”. They have unique insights into the relative strengths and weaknesses of local agriculture and are pre-eminently qualified to contribute to the formulation of a national agricultural policy, which should become the basis for investment plans. The experience of some Asian countries, e.g. China, Vietnam, Bangladesh or Indonesia, has shown how targeted investments, pro-poverty research and farmer empowerment can unlock sustainable economic growth while safeguarding the environment.

As such, agriculture in these countries was recognized as the “backbone of the economy”, steady flows of safe and nutritious farm produce were generated, and large sectors of the population were lifted out of poverty. Due attention to farmer education, ‘One Health’, and an ecological intensification of agriculture have proved to be essential in this regard.

The COVID-19 pandemic now provides the momentum to shape such transitions, giving a new impetus to Africa’s economic development. The traditional partners can act as co-financiers instead of direct benefactors. The ambitious youth – who all too often beckon to Europe – must be actively engaged. Their leadership is crucial to reduce hunger and malnutrition, build a dynamic agricultural sector and create a better future for millions of families. In addition to infrastructure investments, a migration pact could be considered to promote the return of skilled workers to Africa.

Setting sound priorities

Africa is a diverse continent with tremendous natural and human capital and endless possibilities. A flourishing agricultural sector (primarily geared to local and regional markets) can reduce the root causes of migration between rural areas, cities and Europe. Africa should not be further patronized by the North, for it can take matters into its own hands – with external technical and / or financial support, where and when demanded by the local experts. Let us stop pretending that westerners have all the expertise for African agriculture.

Equal trade and tax relations between the EU and AU are essential preconditions for no longer misusing Africa just as a resource. Stable and fair world market prices for products such as coffee and cocoa can contribute to rural development and lift living standards of the rural poor. The role and responsibility of the African political class is central to this. In that context, it is also essential to take the recently launched “African Continental Free Trade Area (ACFTA)” as a serious starting point.

The UN Food Systems Summit 2021 can provide the right momentum for a new global agricultural policy based on regional self-reliance, equality and a preservation of Planetary Health. In Africa and across the globe, agriculture can and should become a regenerative force, with smallholder farmers as stewards of biodiversity and guardians of human health. The immense potential and socio-economic reach of Africa’s agricultural and food system should not be overlooked, and the aforementioned transition must be tackled as a matter of priority.

Thanks to Orlando de Ponti and Martin Smith

About this 4SD Reflection

This article is a reflection by Ad Spijkers following the COVID-19 Open Online Briefings of Dr David Nabarro.

Ad worked as Representative of the Food and Agriculture Organization (FAO) of the United Nations. He is part of a group of Wageningen development veterans with extensive experience in Africa and Asia.

Participants of the COVID-19 Open Online Briefings are invited to share their reflections on how they are navigating complexities from their own perspectives. The views and opinions expressed in these reflections are intended to inspire greater systems leadership during the COVID-19 pandemic. They do not necessarily reflect the official policy or position of 4SD as an organisation or it’s associated personnel. Any content provided by authors are of their opinion and are not intended to malign any religion, ethnic group, club, organization, company, individual or anyone or anything.

We listen, we learn, we care and then we act

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By Miles Bredin.

David is an old friend and colleague of my wife, Jo Nickolls. They worked together on ebola. When I practised for COVID-19 by very nearly dying of H1N1 in 2019, David used systems leadership to harvest a huge honeycomb of knowledge and contacts to help save save my life; Katherine, another member of the 4SD team, once lent us her house for Christmas…

I joined the online briefings in the context that these were good, inspiring, clever people but also wanting to know as much as possible about covid-19. Little did I know that 4SD would guide my thinking on so many broader issues.

Inspired by David, John, Katherine, Thuy, Julien and Florence we have been able to refine our strategy at my company, Well Made Strategy , so that we are now acting with purpose in all that we do. We are a social enterprise and have only ever worked with partners doing great work, turning down jobs with people with whom we disagree. The need for social justice and equity guides all our work. But, ours is a weird case: we provide strategic communications advice in many disparate fields. Indeed we market ourselves on the basis that we are not specialists in anything save communications.

We don’t act for people – like a PR company – we help our clients to act for themselves. As well as private business, we work on learning, health, SGBV, the environment, human rights; the list is endless. Basically, if someone’s doing something good, we help them to do it better. How therefore could we define our purpose?

The blog below tells the story of how our team decided the climate crisis was something we could address with all our partners, setting the example ourselves and helping them to join us. We hope it inspires you to define your purpose and act upon it.

Please have a look and share far and wide.

Taking Action on the Climate Crisis: How WMS plans to work on the Climate Crisis

Free books! Competition!

By TEAM WMS (originally published on LinkedIn)

Well, we made it to February! And if the last year has taught us anything, it is that we must all play our part. The covid-19 response is all about our own personal contributions to the bigger system, our responsibility each to act for the good of others. We must work together to thrive and if we all do our part, things will get better!

That applies to individual people wearing masks to protect their fellows and it applies to governments supporting Covax to protect their fellows.

Somewhere between washing our hands, physical distancing and wearing masks, we were hit by an insight! The exact same thing applies to the climate crisis. Only thirty years late…

As the US once more accepts its climate crisis responsibilities, so must we.

While WMS has a great record of working with organisations on the environment, covid-19 has helped us to rethink our approach and make it more intentional. Last year WMS partnered with many diverse organisations working on their covid-19 response and we saw that while, like the pandemic, the climate crisis affects all aspects of human life, our environmental work at WMS was siloed when it should be infiltrating all that we do. We did great work on climate with Future Earth but how did our work with the Regional Education Learning Initiative tackle the climate crisis?

The world now understands that health care is a security issue. So is the climate crisis. And the climate crisis is a human rights issue, an education issue and an equity issue too.

We know that covid-19 is worse in the rest of the world than it is in Africa – but I’m afraid we are catching up – and yes, we know that the rest of the world is a greater greenhouse gas contributor than we are. Neither fact should stop us from trying to address the crisis for ourselves. And in March last year we were lucky enough to find a guide – Dr. Myriam Sidibe. It has been an eye-opening partnership!

Working with Unilever and UNICEF, Myriam Sidibe has spent decades designing handwashing behaviour change programmes that have reached over a billion people across the globe. And as the world began to plan the covid-19 response all eyes turned to the world’s first doctor of handwashing.

Myriam approached WMS for help with the launch of her book at the start of the pandemic, just as she co-founded the Nairobi Business Compact to address covid-19 in Kenya. She has written a how-to guide that rivals in practicality our own Communications for Social Change Handbook.

Myriam’s book Brands on a Mission encourages organisations in both the public and private sector to go beyond having a purpose to living that purpose and what’s more: it shows us how. Working with Myriam helped us figure out how to use the Sustainable Development Goals to reorient our work on climate.

We feel strongly about positive social change, so we choose our partners as much as they choose us and we have had great success helping all sorts of organisations – business, human rights, child protection, learning – to reach their goals. For years – as many of our partners will remember – we have been teaching how clever the United Nations Environment Programme was at getting the environment into so many of the Sustainable Development Goals. Now we will do it too.

This year at Well Made Strategy we will be expanding our Environmental Social and Governance communications practise and urging all our partners to put the climate crisis at the forefront of their planning. We’ll be reducing our carbon emissions and addressing the climate crisis in all our work.

To embed the climate crisis in all that we do we will be using advice on systems thinking and leadership from the WHO Covid-19 Envoy Dr. David Nabarro and his team at 4SD. As they teach at 4SD, you need to identify all the players in a system, then work out how they relate to each other. To start on that we are launching a competition. In time this will help us to “understand and quantify the impact of those relationships on each other and on those outside the system”.

We commit to going beyond caring about the climate crisis to embedding climate work in all we do.

This will allow us to address equity, justice, nutrition, disability, learning, even female genital mutilation and all of the other issues that drive our work.

Of all the issues that we address daily at WMS, we have found one we are passionate about that can further all our other concerns. And Myriam Sidibe has taught us how to incorporate this into our work.

As we set out, we think you should all know Myriam! So, we’re giving away ten signed copies of her book to people who can best describe what they feel passionately about and what they’re going to do about it.

Dare you tell us?

Follow us @WMSComms and tell us in a tweet what you are passionate about. Tag it #vision21.

And if you’re outside Kenya, we’ll send you an e-book.

About this 4SD Reflection

This article is a reflection by Miles Bredin following the COVID-19 Open Online Briefings of Dr David Nabarro.

Miles is a bestselling author and former foreign correspondent. He was United Press International’s last East Africa Bureau Chief and private sector strengthening advisor to the Afghan Minister of Finance. He was a Paul Mellon Fellow at Yale’s British Art Center and has written a number of books. Miles set up Well Made Strategy with Rob Burnet, founder of network of social ventures Shujaaz Inc in 2009. Well Made Strategy has devised and implemented communications strategies across Africa and beyond.

The feature image is a COVID-19 campaign in Kimaa (Maasai language) by Well Made Strategy and friends at Shujaaz and the Africa Educational Trust which were distributed in Tanzania and Kenya.

Participants of the COVID-19 Open Online Briefings are invited to share their reflections on how they are navigating complexities from their own perspectives. The views and opinions expressed in these reflections are intended to inspire greater systems leadership during the COVID-19 pandemic. They do not necessarily reflect the official policy or position of 4SD as an organisation or it’s associated personnel. Any content provided by authors are of their opinion and are not intended to malign any religion, ethnic group, club, organization, company, individual or anyone or anything.

Strength of character through the global pandemic

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By Jane Aslanidis.

On the first of January 2020, I was choking on the smoke created by the horrific bushfires in New South Wales, Australia. One year later, on the first of January 2021, I was indoors under London’s third lockdown to save lives and protect the NHS. In the face of these disasters, our own life plans suddenly seem insignificant.

My experience of moving to the UK and learning about a new culture has reaffirmed the value of relationships to me. I am fascinated by the human experience. When I arrived in the metropolis  of London I quickly learnt people here generally value their anonymity, ‘cold and stiff’ is a generalisation for the weather and the attitudes. At 8pm on 26 March 2020, the instigation of Clap For Our Carers gave me goosebumps and transformed my neighbourhood. Today, local business owners smile, wave and we not only know each other’s names, we look out for each other.

My community is not limited to outside my doorstep. Technology solutions and online forums have allowed us to feel more interconnected than ever before. As a professional changemaker, I convene with organisations to explore issues that have meaning and impact on many people and cultures. Much of the work I do sits at economic, technology, political, climate and humanitarian crossroads. I’ve designed and facilitated over 1,000 workshops, conferences and convenings and over the past few months, I’ve noticed the accessibility improvements in video conferencing are empowering those traditionally left out of the conversation.

For example, I mentor entrepreneurs and grassroots activists in places like Mysore, Athens, Freetown – in villages, on farmland, in co-working spaces. No longer do we feel we have to wait to travel to each other to talk about challenges, we’ve adapted our discussions to video conferencing. We speak candidly about our personal experiences – with a shared realisation of the stress the virus creates for systems – from local food systems to the international system. Just when we need collective action more than ever, support for the international system has been deteriorating as countries look inwards. An unequal distribution of vaccines in vaccine nationalism paired with closing cooperation, borders and supply chains is shaping a concerning start to the year.

Despite this, and through my experiences and those of my community, I have noticed three themes emerging:

Systems leadership is more important than ever

I define systems leadership in the international system as individuals and countries who are able to step up and bring collective leadership. Whether large or small, this includes interventions and convenings that aim to bring together those divided to face common challenges collectively and build a new system.

4SD explores what comfort in complexity means, engaging with living systems and seeing into multiple systems. Amanda Gorman’s stunning poem at Biden’s inauguration in the United States, one of the most severely affected countries by the virus and political turmoil, demonstrates what the next generation of system leaders can look like.

Fact-based communications in an era of mistrust 

Dr David Nabarro shared in the latest COVID-19 Open Online Briefing the difficulty of rebuilding trust in the international system. Fact-based communication is needed to communicate our messages given the large amount of misinformation.

Trust in governments and international institutions is suffering, with unsustainable or misleading information provided, and false promises of hope or freedom in sight. The legitimacy crisis institutions are facing has been exasperated in the past decade. The UK government in particular is suffering a trust crisis. Last week, the 2021 Edelman Trust Barometer revealed a trust bubble in May 2020, with a sudden rush of trust towards government, to a particularly acute loss of confidence in the UK government by year-end.

I’ve learnt that advocating for people and communicating clearly with them, listening carefully to the needs of marginalised communities is a top priority in the face of a crisis. Clear communication and inclusion of low-income communities and non-English speaking audiences, including immigrants, is particularly important in public health campaigns.

Designing solutions for humanity and the planet

Fundamentally, intertwining economic policy and climate policy will not only strengthen government’s adaptability and resilience to the impacts of climate change, it will also demonstrate leadership and the ability to listen to their citizen’s needs:

  • reaching zero emissions sooner,
  • being open and transparent with how metrics could be achieved,
  • a commitment to report progress and rigorously evaluate and iterate where required,
  • designing for those invested in the place and process – with people, institutions and nature on equal footing and,
  • not jumping to consultation or coercion but designing with intention, true collaboration and real investment in solutions.

The year ahead is offering each and every one of us the opportunity to shape and change how we live our lives like never before. Many of us have resolved to purge ourselves of the “old ways” – of living, connecting, working and convening. My recent experiences have led me to a final reflection – how you lead your community in a pandemic says a lot about your character.

About this 4SD Reflection

This article is a reflection by Jane Aslanidis following the COVID-19 Open Online Briefings of Dr David Nabarro. Jane is an international relations expert. Currently a senior manager at the Boston Consulting Group’s Centre for Public Impact and a former consultant at the United Nations World Food Programme.

A business owner, non-executive director and youth advocate, she has built and led community initiatives from the grassroots-up, and is now overseeing and designing global initiatives from the top-down. Jane welcomes any conversation to navigate, innovate, influence and advocate with others, bringing boldness, pragmatism and a strong set of values to all that she does.

Participants of the COVID-19 Open Online Briefings are invited to share their reflections on how they are navigating complexities from their own perspectives. The views and opinions expressed in these reflections are intended to inspire greater systems leadership during the COVID-19 pandemic. They do not necessarily reflect the official policy or position of 4SD as an organisation or it’s associated personnel. Any content provided by authors are of their opinion and are not intended to malign any religion, ethnic group, club, organization, company, individual or anyone or anything.

Work-life balance: Care, Connection, Compassion for a Change

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work-life balance image

Photo by Saitarg via Iwaria

By David Nabarro, Strategic Director of 4SD – Skills, Systems & Synergies for Sustainable Development.

Addressing the complex challenges that underpin the 2030 Agenda is accompanied by a great deal of stress. Breaking silos and engaging people from many cultures and disciplines means stepping out of our comfort zones. Catalysing partnerships and action requires a lot of energy and the courage to expose one’s self. The question thus arises: how can we manage our own stress levels so that we not only do our work, but also are present for our family and friends and navigate life with joy and compassion?

So… how can we optimize our personal capacity to be agents of positive change, at home, in our community and in the workplace?

Here are a few tips that work for me:

  • Focus on one thing at a time: More and more evidence demonstrate that multi-tasking is a myth! As humans, our brains perform better when engaging fully in one thing. So, let’s fully engage, and fully disengage, to be fully present to the task or the person at hand.
  • Meet people, fully and right where they really are: The way people show up is the way they show up. We can’t force them into holding our point of view. We can’t make them move faster than they are prepared to go. So, at home as much as in our workplace, let’s cultivate our curiosity for people and their stories and quiet our judgements. Let’s see people, hear them and engage with them from where they are, not from where we feel they should be. We will save our precious energy to move on with the potential that exists, however great or small.
  • Connect with people with warmth: Always connect first, with smile and eye contact when possible, empathy and real curiosity for what each person brings. It facilitates trust, communication and absorption of ideas. Smile on the phone, the person you are talking to will feel it and open more easily. Pause whatever else you were doing, and engage fully, from your heart. There is always something to learn, another perspective to discover, another story to unveil.
  • Take your job seriously, without taking yourself too seriously! Hold your lightness through even the most serious circumstances. Whatever prize I get, however serious or high level the group is that I engage with, I wear fun socks! Most people don’t see them, but they are my important reminder to have fun and not take myself too seriously.

There are many other tips and practice that can help us balance our busy lives. Connecting with people, fully and warmly, with passion and humility, is the one that keeps me going! At times when I cannot manage, I depend on this.

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