Meet Göran Tomson, Distinguished Fellow
Göran Tomson is a Professor of International Health Systems Research, linked to Medical Management Centre (MMC) at the Department of Learning, Informatics, Management and Ethics (LIME) at Karolinska Institutet. He is a Counselor UN Agenda 2030 at the President’s office at KI. He is a co-founder and a Senior Advisor at the Swedish Institute for Global Health Transformation (SIGHT) at the Royal Swedish Academy of Sciences, and Co-founder ReAct the international network to contain antibiotic resistance, responsible for coordinating the work that led to the Alliance for Health Policy and Systems Research now at WHO.
Göran’s extensive research and policy work focuses on universal health coverage and has been conducted in countries such as China, Kenya, Lao PDR, Sweden, Tanzania, Uganda, Vietnam, and Zambia and his experience in the field of health policy and systems research has led to his appointment to various organizational committees. He has a major interest is in capacity building (institutional and individual), and has supervised 40 PhD students.
Tell us a bit about your background and current roles.
I carried out my professional medical training at the Karolinska Institutet (KI) in Stockholm where I am now senior counselor at the President´s Office on the UN Agenda 2030, and professor in international health systems research. Further, I am currently senior advisor at, and co-founder of SIGHT (Swedish Institute of Global Health Transformation) at the Royal Swedish Academy of Sciences, Stockholm and visiting professor at Shandong University, China.
What led you to become interested in health systems?
When I started working as a paediatrician at a university hospital in Stockholm I was unaware of the importance of socioeconomic factors for children´s health and well-being. Practicing as a paediatrician was part of a gradual awakening for me. At the time I was doing research on trans-placental passage of meperidine (passage of the medication meperidine, used for pain relief, from the mother to the foetus through the placenta). Increasingly, my interest turned to individuals, the health system and public health. In part, this was as a result of being influenced by my mother´s solidarity with those less fortunate; but I was also becoming increasingly aware of appalling inequities globally.
So my PhD studies instead combined anthropology, epidemiology and pharmacology to better understand the use of the most popular element of health systems – medicines. My field work was carried out in Sri Lanka. From there onwards my area of expertise was what was then called international health (now global health). Health systems research, and in the beginning particularly the rational use of drugs (medicines), became a specialty of mine. Gradually, my interest widened to include the complexity of health systems with its subsystems (Fig.1 in my blog ) - especially interventions to ensure universal health care of good quality with a focus on Low and Middle Income Countries (LMICs).
You’ve been working in health systems research for over thirty years. When you look back, what are some of the highlights?
There are many. I have been fortunate to work with great individuals. Between 1995 and 2015 I led the Health Systems and Policy research group at KI, assessed as outstanding in an external evaluation in 2010. A special interest has been individual and institutional capacity building, and it has been my privilege to supervise and learn from 40 PhD students from all over the world. Many of them are now full professors, directors of research and deans of institutions. A former postdoc is now head of health at UNICEF in New York.
Between 1992 and 2002 I led a large national drug policy programme in Lao PDR (then one of the poorest countries in the world) financed by Sida - the Swedish development assistance agency. When the Lao government sought help they had identified self-medication and proliferation of substandard or fake drugs as their main issues. With the help of small scale health systems research projects it was possible to identify other problems in need of a more comprehensive approach. In a remarkably short period of just one year a completely new drug policy was formulated and adopted (published in the Lancet). The policy formulation was a domestic affair with ten ministries. A drug law, a quality control centre and treatment guidelines were some of the deliverables. After a while it became evident that the implementation of the policy did not proceed as expected.
To enhance the process in a context sensitive way, health systems research training was introduced as an element in the policy. My KI team led a process to train researchers, policy makers and practitioners in priority-setting, identification of issues and methods of implementation, as well as data collection and report writing. Themes included the rational use of drugs, the effects of regulation on private sector performance, and quality of drugs. The minister of health at the time acknowledged that the strengthening of human resources and the development of institutions and health systems research facilitated more evidence for informed policy and decision making. The Lao experience is among the more gratifying professional processes I have been involved in.
Networking has been another special interest of mine. This can unite people, harness their ideas, and energise and mobilise them for activities in need of attention. Representing Sweden has its advantages given its history of engagement globally. Together with visionary change agents globally I have tried over the years to ‘challenge lazy orthodoxies and aspire to be a disruptive innovator’, as Richard Horton wrote about myself and the other co-founder of SIGHT in a Lancet commentary in 2017.
Networks and alliances I have co-founded (in one case coordinated preparatory work - AHPSR) in areas then receiving little attention are set out in the table below.
INRUD - International Network for Rational Use of Drugs
INRUD focuses on LMICs
AHPSR - Alliance for Health Policy and Systems Research
I coordinated the preparatory work in 1997 and have since 2002 served in various roles on the Scientific Technical Advisory Committee. Hosted by WHO Geneva.
ReAct - The International Network to Contain Antibiotic Resistance hosted by Uppsala University, with regional hubs
EVIPNet - Evidence Informed Policy Network at WHO HQ, with regional hubs
SIGHT - Swedish Institute for Global Health Transformation at the Royal Swedish Academy of Sciences
See www.sight.kva.se and GI SIGHT video.
Tell us about your work with the WHO Alliance for Health Policy and Systems Research (AHPSR).
In 1996 The Ad Hoc Committee on Health Research Relating to Future Intervention Options identified health systems research as one of four priority areas. The Norwegian and Swedish governments were commissioned to explore this and I was asked to coordinate a small working group paving the way for what became the Alliance for Health Systems Research, which became operational in 1999. In its 20 years of existence, the Alliance has risen to the burgeoning demand for evidence on health systems strengthening, by shepherding the growth of the health policy and systems research (HPSR) field through the production of definitive methodological texts and materials and the creation of a vibrant community of partners and grantees, particularly research institutions and ministries of health in LMICs. The small secretariat has for many years been hosted by the WHO at its headquarters in Geneva.
The Alliance has heralded a shift away from passive knowledge production in the arena of health systems to catalysing demand and use of knowledge by health systems decision makers, by engaging them in setting research priorities, co-producing research, and institutionalising knowledge use for health system improvements. The multi-disciplinary nature of the work is emphasised. Key deliverables over the years include the Flagship report Systems thinking for health systems strengthening, The Reader in Health Policy and Systems Research and since 2010 co-organising the Global Symposium on Health Systems Research every second year. One of the most significant factors driving the HPSR field has been the recognition of the importance of strong and resilient health systems - the Ebola crisis being just one of many examples. An issue has been the presence or absence of the ‘P’ in HPSR. From the start, even in the planning phase of AHPSR, it was considered important to include the ‘P’, underlining the close link between research and policy as well as the importance of doing research not only for but also on policy. The focus of the work is on LMICs but increasingly some products are also being used in HIC institutions.
To summarise, the Alliance objectives are to:
1. provide a unique forum for the HPSR community;
2. support institutional capacity for conduct and uptake of HPSR
3. stimulate generation of knowledge and innovation to nurture health system learning and resilience; and
4. increase demand and use of knowledge for strengthening health systems.
What does it mean to be a Distinguished Fellow at The George Institute?
Firstly, reconnecting - I was invited to Australia three times during the early 90s, twice to Sydney in conjunction with the launch and implementation of the Australian pharmaceutical policy, at that time arguably one of the most dynamic in the world. I much appreciated the ambiance, openness, pioneering spirit and creativity. I hope to experience the same in the interactions with The George Institute now dealing with global health, including health systems. Secondly, the Fellowship gave me an incentive to look back and try to summarise my professional trajectory - something I would not have done otherwise. I am humbled by what I have been part of, and understand that as much as I am an academic I am also an entrepreneur and “builder” who has been fortunate to see windows of opportunity in partnering with outstanding professionals. The UN Agenda 2030 with its SDGs and targets aims to transform the world for sustainability. The Academy must contribute, as must SIGHT. To have something meaningful to aspire to is a blessing. I hope to learn and contribute further here in partnering with The George Institute, including leveraging my networks.
By the way, Göran is Swedish for George.