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Emilie Robert Observatory of free healthcare in Mali 2012


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This presentation was given at the 2nd global symposium on health systems research, in a panel on knowledge translation strategies in West Africa to promote access to healthcare. This panel which I organized was chaired by Valéry Ridde. The symposium took place in Beijing (China) in November 2012.

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Emilie Robert Observatory of free healthcare in Mali 2012

  1. 1. Global symposium on health system research (Beijing, 31 oct. – 3 nov. 2012)Producing and transferring local knowledge Emilie Robert Dembélé Youssouf
  2. 2. Outline1.  Context2.  What research knowledge (RK) was transferred?3.  To whom was the RK transferred?4.  By whom was the RK transferred?5.  How was the RK transferred?6.  With what effect was the RK transferred? © Robert & Dembélé, 2012
  3. 3. ContextSeveral free care policies: •  Free care for under 5 (NGO) •  Distribution of free mosquito bednets (gvt+NGO) •  Free malaria treatment (gvt) •  Caesarian (gvt) •  HIV treatment (gvt)Objectives:To use existing data from theinformation system and toproduce new knowledge tofuel decisions on user feeexemption policies. MALI © Robert & Dembélé, 2012
  4. 4. 1. What RK was transferred? (1) Dimensions RK produced by the Ministry of RK produced by health University of Montréal -  Curative consultation coverage in Kangaba -  Effects of free care of -  Access to C-section in Bamako. curative care for children -  Effects of free ACT on accessibility of under 5 on consultation inUtilization of Kangaba children living further than 5 km from ahealth services community health centre (CsCom) -  Effects of free mosquito bednets on prenatal care in Sikasso -  Effects of free anti malaria on financial -  Costs of curativeFinancial capacity of community health centres consultation for childrenaspects / costs (CSCom) in Bamako under 5 (scaling up)of UF exemption -  Effects of free care on financial capacity ofpolicies community health management (ASACO) in Kangaba -  Perception of health staff on free anti malaria in Sikasso and KayesActors’ -  Perception of users on free anti malaria inperceptions of Sikassofree care -  Opinion of Kangaba population on cessation of free care for children under 5 © Robert & Dembélé, 2012
  5. 5. 2. To whom was the RK transferred? Internal level•  Participants in Observatory (HIS officers, district medical chieves, regional planning officers, national HMIS managers) External level•  Ministry of health (national director, planning and statistics chief, general secretate) + non participant regions•  NGOs (MDM, MSF, ACF, HKI) and national civil society (Fédération nationale des ASACO)•  Donors (ECHO, EC, World Bank, WHO, UNICEF)•  Bilateral agencies (France, Canada, Netherlands, USA) © Robert & Dembélé, 2012
  6. 6. 3. By whom was the RK transferred?•  Supervision team –  University of Montreal, researchers with technical expertise –  Médecins Sans Frontières – Belgium: coordination of the strategy and fundraising –  National Directorate of the Ministy of Health: operational side of the research, access to the health system information © Robert & Dembélé, 2012
  7. 7. 4. How was the RK transferred?•  Modelization of the knowledge translation strategy theory (post-intervention)•  Objective: → To evaluate the potential for achievement of the KT strategy•  Sources: –  Interviews –  project documents –  KT literature © Robert & Dembélé, 2012
  8. 8. INPUTS Administrative and financial support during 12 months; UdeM / MoH / MSF-B / ECHO partnership ; human resources; equipments; consumables; infrastructures Participative process PROCESS Implication of target users in Involvement of local Support to the Adaptation and identifying needs for stakeholders in Observatory to produce dissemination of knowledge producing knowledge knowledge knowledge Preparation of protocoles Building of the teams’ Publication of policy briefs Workshop for the by the Observatory teams technical capacities on new knowledge identification of needs for ACTIVITIES knowledge Presentations at local Conduct of studies by the Supervision of the Observatory teams production of knowledge meetings Prioritizing needs for knowledge with Utilization of HIS data Conduct of independant National dissemination Observatory teams studies by UdeM workshopEXPECTED RESULTS Knowledge is useful to The legitimacy of the The credibility of Knowledge is Process target users. Obs. is established. knowlege is ensured. accessible. utilization Better utilization of knowledge in decision-making on user fee exemption measures OBJECTIVE At the At the local At the internat. level national level level© Robert, 2011
  9. 9. 5. With what effect was the RK transferred? Expected Facilitators Obstacles Potential for results achievement1) Knowledge is KT strategy: KT strategy:useful to target •  Involvement of potential users in •  Poor targeting ofusers. the identification of needs decision and policy Context: makers ++ •  Answer to an explicitly formulated need •  MDGs context2) The legitimacy KT strategy:of the •  Endogeneous process ofObservatory is knowledge productionestablished. •  Technical support from partners +++ Context: •  Local initiative and institutional anchoring © Robert & Dembélé, 2012
  10. 10. 5. With what effect was the RK transferred? Expected Facilitators Obstacles Potential for results achievement3) The credibility KT strategy: KT strategy:of knowledge is •  Scientific support from partners •  Validity of dataensured. produced by the Context: Observatory + •  Long-term collaboration between partners •  Short-term trainings and one-year strategy4) Knowledge is KT strategy: KT strategy:disseminated and •  Workshop and policy briefs •  Push strategyaccessible. Context: •  No dissemination plan - •  Strong involvement of key •  Participants with low stakeholder (messenger) leverage5) Process KT strategy: KT strategy:utilization •  Better understanding of the ins •  No national potential and outs of free healthcare at the users involved in the local level process + •  Trainings •  Life span of the KT Context: strategy •  Mid-term sustainability © Robert & Dembélé, 2012
  11. 11. Youssouf Dembélé is the Executive Director of the Alliance Médicale Contre lePaludisme au Mali.Emilie Robert is a Ph.D. student in public health at Montreal University (Canada).She is working under the supervision of Dr. Valéry Ridde. She is a senior fellow ofthe Global Health Research Strengthening Program (GHR-CAP), funded by theCanadian Institutes of Health Research and the Population Health ResearchNetwork of Quebec. She holds a scholarship from the Quebec Fund for Nature andTechnology Research. She has a travel grant from the Research centre ofUniversity of Montreal hospital centre (CRCHUM).Contacts: / emilie.robert.3@umontreal.caAcknowledgments to the team: •  Dr. Valéry Ridde, Montreal University •  Dr. Slim Haddad, Montreal University