SUB SAHARAN AFRICA HEALTH STRATEGY SIMULATION

Following press articles about an Avian Flu simulation, the organisers of Cheltenham Science Festival asked if Simulstrat could produce something similar for the festival, to broaden awareness of health issues in Sub Saharan Africa beyond the single issue focus on AIDs treatment.

To complicate matters it had to be playable by teams of fifteen year-olds drawn from a mixture of schools and a team of business leaders and scientists. No concessions were to be made for age. Players were presumed to have nothing more than normal background knowledge. Teams had to bring participants from science and the arts to work together.

This is the story of the simulation and its results.

RESULTS FIRST

The game closed at exactly 16:30 on June 8th, 2007. Participants and observers knew it had been a success. The quantity and quality of output was obvious.

Teachers observing the game could scarcely believe that 15 year olds could sustain enthusiasm and high quality output under pressure for 6 ½ hours - non stop.

With variations that reflected their own interpretation of risk, all four student teams had created coherent integrated health strategies.

They had linked primary and secondary care, and built a coordinated approach to infectious disease that spanned treatment, preventive education and environmental control. Terms such as ARV, Oral Rehydration Therapy, TB Dots, Integrated Management of Childhood Illness were being passed around with confidence by students who had never heard of them at the start of the game.

At a working lunch each team made a televised press statement covering their position on DDT and the Stockholm POPS treaty. All four student teams produced excellent defences in favour of a controlled defiance of the ban in order to tackle malaria.

For equally valid reasons the adult’s team chose to comply with the treaty. This honours a fundamental principle of simulation: it should be possible to generate multiple plausible and valid versions of the future.

SO HOW WAS THIS DONE AND DOES IT HOLD VALUE FOR OTHER ORGANISATIONS?

The Lodestar project is now a packaged simulation that is relevant to any organisation that needs to :-

• Explore health strategy

• Break down silos between departments

• Create collaborative working in teams

• Develop communication and decision making skills

• Educate groups in complex interwoven concepts

• Persuade groups to identify with a problem and produce original solutions

Simulstrat’s academic founders are King’s College London Professors with world reputations in strategic analysis and risk (Sir Lawrence Freedman, Mike Clarke and Ragnar Lofstedt). They commissioned a design that assumed only basic knowledge in some participants and was credible with players who were experts.

The simulation was a table-top exercise that could be played in one day. It divided health strategy into 15 projects with the projects grouped under a departmental heading: Care, Treatment, Education and Environment.

The projects were presented in a standard card format with each project card showing a projected impact on the Millennium Development Goals (MDG).

PLAYER BRIEFING

Stage one of the game was the most critical.

Before discussion could begin the teams needed to understand all the individual projects, how they fitted with the departmental strategy and how projects spanned across departments.

This meant asking 36 15 year olds to spend 90 minutes reading and digesting raw data. The teachers agreed that this volume of data could not be handled by any other learning format.

The subject was introduced by a high impact computer animation. Then the teams were told the rules of the simulation and sent to their tables.

The data absorption task was set in bite size pieces. Each team of eight was sub-divided into four pairs. Each pair took on the role of representing their own department. The projects for each department were presented by the relevant departmental managers (sub-teams) and first impressions were collected.

When all the projects had been covered the sub-teams spent a short period in private session and then the group selection process began.

The teams did not have sufficient funding to operate every project – so they had to reach a consensus decision based on jointly agreed priorities. The projects were designed to stimulate discussion.

The players were forced to wrestle with all the classic dilemmas of health strategists. Knowledge of health strategy and terminology was introduced in a calculated sequence via the cards.

To provide further stimulation some terminology was deliberately not explained. This forced teams to make RFI’s (Requests For Information) to a panel of experts called a Control Team.

The Lodestar Control Team was led by Professor Peter Ndumbe who is Dean of the Faculty of Health Sciences of the University of Buea in Cameroon and Dr Gill Samuels Chair-Elect of the Global Forum for Health and Chair of the Cheltenham Science Festival. It also included Professors from King’s College London (Wyn Bowen and John Gearson) and Simulstrat researchers Dr Sara Ulrich and Dr Susie Holdsworth.

Conversation was conducted via Skype Instant Messaging – which is a popular format with teenage students. The dialogue was logged and captured for review after the event.

SKYPE CHAT

[08/06/2007 10:07:14] Simulstrat D says: what is DOTS and how effective is it???

[08/06/2007 10:08:13] Simulstrat D says: what is ACT???

[08/06/2007 10:11:08] Simulstrat Control A&B says: DOTS is a way of administering TB treatment over 6 mths to increase its effectiveness It stands for Directly Observed Therapy

[08/06/2007 16:27:32] Simulstrat A says: howz you we finished it was gr8 day :D

[08/06/2007 16:29:14] Simulstrat Control A&B says: (smiley)

[08/06/2007 16:29:50] Simulstrat A says: (inlove)

BREAKING DOWN "SILOS"

The need for collaboration was vital. This led to the dismantling of departmental boundaries and the adoption of a group stance to maximise progress towards the MDGs.

All the student teams and the adult team adopted this posture. One of the student teams even formally voted to do this at the beginning of the group discussion.

In the final stages of selection the teams entered their choices in a computer model that calculated performance against the MDGs and the number of lives saved.

IMPORTANT OUTCOMES

A full analysis of the data collected has not been concluded but there are some important initial findings.

• Strong identification with Africa – During the Hot Debrief all of the teams identified far more closely with health issues in Africa. They saw a much closer link with health development in the UK than they had previously realised.

• Understanding of the need for integration of Care, Treatment, Education and Environment policy.

• Understanding of the complexity of AIDs in terms of treatment and links to secondary diseases.

• A need for local health coverage based on local evidence based epidemiology

• A belief in the right of African nations to choose their own health priorities

• Less interest in talking about corruption and more emphasis on action.

CONCLUSION

The Cheltenham Lodestar simulation was a resounding success.

The game brought everybody to a common standard where decisions could be made after group discussion. The group discussion had to appeal to general principles and concepts that all players could deploy on an equal status.

The teams exercised non-stop from 10:00 – through a working lunch to 16:30.

• The "gaming" methodology of learning through role playing and personal experience effectively educated a wide range of participants in the key principles of health strategy.

• Transformed attitudes and energised players to work for a long period under sustained pressure.

• It left the participants highly motivated and stimulated by the subject matter.

All of this is typical of the experience when using the simulation and game format.

INVITED EXPERTS - CONTROL TEAM

Professor Peter Ndumbe - Dean of the Faculty of Health Sciences of the University of Buea, Cameroon

Dr Gill Samuels CBE – Chair Global Forum For Health, Chair Cheltenham Science Festival

Professor John Gearson - KCL War Studies

Professor Wyn Bowen - KCL War Studies

INVITED EXPERTS - PLAYER TEAM

Sir Michael McWilliam - Chair Royal Commonwealth Society

Cathy Heseltine - VP Marketing EMEA, Starbucks

Sophia Tickell - Director Pharma Futures and Chair of Sustainability

Mike Phillips - Managing Director, Mclaren F1 Applied Technologies

Professor Sandy Thomas - Director, UK Government Foresight Initiative

SIMULSTRAT RESEARCH AND CONTROL

Dr Susie Holdsworth

Dr Sara Ulrich

Dr Rob Stephenson

Mr Ken Charman

SIMULSTRAT TEAM MENTORS

Air Vice-Marshall Stephen Chisnall - (RAF)

Mr Stephen Corkett

Brigadier (retd) Stephen Matthews - CEO of Chartered Institute of Building Services Engineers

Mr Rob Todd – Director, Adventus