Get to know PSI-Europe's newest board member, Christine Fenenga.

1. What should we know about Christine Fenenga?

I was born on Schiermonnikoog, a small Island in the north of The Netherlands with just 750 inhabitants. As a child I studied on the island, but at 16 I had to leave for the ‘mainland,’ and did my Physiotherapy study in Groningen. When I graduated in the eighties, it was extremely difficult to find work in The Netherlands. I seem to have inherited my enthusiasm for exploring the world from my father, a captain at a large shipping merchant, because I went on to work in hospitals in the UK, Israel, and then Norway; where I later continued my training to work in Tanzania. That leap—from working in a well-equipped hospital in Stavanger to a regional public hospital in Morogoro—was enormous. I felt overwhelmed by the conditions of the health facilities and at the same time very motivated to contribute. Finding a way to ‘survive,’ I also felt an eagerness to learn more about the people, the culture, the way the people perceived illness and (traditional and formal) healthcare services. That interest drove me throughout my work in Malawi, Indonesia, and other counties; and it still does today.

In between my contracts, I continued studying. I hold a Master’s degree in Public Health from the University of Liverpool, UK (1997) and studied Medical Anthropology at the University of Amsterdam (1998). My PhD thesis ‘A Matter of Trust’ (2015) examines the socio-cultural determinants that influence clients’ behaviour and decisions to utilize healthcare and health insurance services in Ghana.

Since 2000, I have been based in The Netherlands and have worked for various organizations (Cordaid, PharmAccess International, Taskforce for Global Health) in program management, policy development and research in Africa and Asia. The focus of my work has been on health systems strengthening, innovations in health financing (e.g., health insurance), and sexual and reproductive health and rights. During this period, I served on the boards of two small health NGOs for several years. In 2020, I started my own consultancy in Amsterdam under the name Global Health Inclusive and work on assignments with governments, international organizations, and Dutch NGOs.    

2. How did you come to know PSI-Europe and what resonates with you about PSI-Europe’s work and mission?

I met and became interested in PSI while working with PharmAccess International when PSI, PharmAccess International, and other local health partners collaborated on a large primary healthcare project. Later, I realized that PSI also had a European member in its network, right on my doorstep in Amsterdam! So when I was recently invited to join their board, I felt very honoured.

What appeals to me about PSI-Europe is the strong focus on the voice of the people—the health consumer and their families. In my research in Ghana, I was able to demonstrate how important that is. I found socio-cultural values and social capital impacting people’s perspectives and health seeking behaviours. Understanding people’s views and listening to their stories about barriers to healthcare enriches the development of successful health interventions and contributes to building trust. To achieve this requires a mind-set shift among healthcare providers, program managers, and policy leaders.

Another aspect of PSI that resonates with me is the strengthening of global capacity through growing diverse, high-performing teams and bringing in innovative techniques and partners. Each setting asks for a tailored approach and diverse partners that bring different capabilities to build sustainable and consumer-powered healthcare. Digital developments have been particularly important innovations in recent years. My years in the field taught me that collaboration and coordination with local authorities and non-governmental organizations is extremely important to avoid fragmentation and to enhance ownership and embeddedness, something PSI-Europe also clearly values. PSI-Europe’s emphasis on innovation and partnership—with other NGOs and with public and private sector partners—is critical for building responsive and sustainable health systems.  

3. What does PSI-Europe’s focus on consumer-powered healthcare mean to you?

Consumer-powered healthcare has been my key interest all along. It is so important to consider the consumers a health system is serving, yet extremely challenging. It requires a multi-level approach: at the community/consumer level, the healthcare provider level, and at policy and advocacy level. This requires diverse skills and collaboration among diverse partners. Working with local PSI teams on the ground in the countries we work, will be of great value to understand the needs of the community, and to advocate for the right support to build capacity. This capacity building concerns the demand side, empowering the community to claim their rights, and of the supply side, strengthening the healthcare providers in offering consumer-centred quality care. Because consumers are diverse, having different needs and diverse, multiple identities, using an intersectional lens is important to reach the most vulnerable populations too. By doing so, PSI truly contributes to Universal Health Coverage (UHC) that many countries embrace today.

4. We at PSI-Europe are big-picture thinkers but also pragmatists. How will you help us think big while activating realistic and actionable agendas?

In my previous work with organizations, questions regarding program effectiveness, efficiency, sustainability, scaling (or reducing), and risk analysis were part of regular policy discussions. In certain cases, taking risks is a must in order to explore new methods or approaches to improve access to quality healthcare. Against all odds you proceed, as it often takes time before the first results can be measured. But when it does, and evidence shows that these new innovations yield the effect you aimed for, you have made an important contribution. I have experienced these in the organisations I worked with, which has been extremely useful for developing my ability to think strategically. I know also PSI has this boldness, this ability and willingness to go beyond the regular boundaries. I hope I can use my experience and contribute to this in my role as board member.

Having worked as program manager as well as researcher, I also believe that linking practice and research is valuable. Demonstrating clear evidence of an innovation yielding remarkable effects makes a strong case for replicating and scaling it, and national programmes may use the evidence to adopt in their policies.

Having worked in the global health sector for quite some years, I built a substantial network. I plan to contribute with suggestions, linking PSI-Europe with people and organizations to explore new initiatives. Keeping an open eye and ear will also allow me to inform PSI-Europe on up-coming opportunities.

5. We are excited to have a health system strengthening expert like yourself on board. How important is it that the public and private sectors work together to build stronger, more resilient, and integrated health systems that better serve the needs of our consumers?

I believe public-private partnership is extremely important. Both the public and private sectors have something unique to offer and complement each other. I would even say that they cannot work without each other. You can find plenty examples in which the public sector alone is struggling to meet the people’s health needs. We are experiencing this now during the COVID-19 pandemic. This is why we need to promote resilient, integrated public and private health systems.

The government has an important regulating role, and a responsibility to ensure that the entire population has access to basic healthcare services. A huge task. The private sector has an important role in testing new innovations and pilot projects. Once a pilot proves effective, cost effective, and scalable, it becomes easier for public services to adopt and integrate. This requires the deep engagement, trust, and cooperation between the public and private sectors. Working in partnership is key.

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6. What do you hope to see in 2022?

Mostly, I hope that this year will gradually be less constrained by the COVID-19 pandemic, although we all know it will not disappear overnight. Vaccination rates in the global south are still extremely low, so there is still a long way to go.

What I miss most is the human contact—being together, visiting projects, sharing experiences, and laughing together about funny stories. We have found a way to manage, but it is often not ideal. I also hope we take some good elements of this period with us. The COVID regulations forced us to think more out of the box. For PSI-Europe, I hope we will be able to embark on some exciting new programs.      

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7. What’s a fun or interesting fact about yourself you’d like to share?

I love classical music and have for many years played the piano and flute and sung in a choir. Having spent much time at home due to the pandemic, listening to music has been a real joy. My husband Kees and I live not far from the ‘Concertgebouw’ in the centre of Amsterdam, a beautiful building of the 19th century. Unfortunately, it is still closed but hopefully it is opening its doors for the public soon again.