Health Systems and Health Research Systems Strengthening the links between research and policy making: Perspectives from I...
India- An overview SOCHARA has worked with the 5 states indicated by red arrows Some indicators Population (in 2007):   In...
Health Systems in India – An overview Central State District State Health  Systems National Health Programs Academic/ Rese...
Health Research Systems in India – An overview Ministry of Health Center State Academic and research institutions CSO Netw...
<ul><li>Multidisciplinary professional resource network in Public Health/Community Health </li></ul><ul><li>Objectives inc...
<ul><li>Interactive/participatory research with pro-active policy advocacy </li></ul><ul><ul><li>Case study: Medical Educa...
Case study – Medical Education in India  <ul><li>Medico Friends Circle reflections (1991) recommends: </li></ul><ul><li>Co...
Case study – Medical Education in India (contd….) <ul><li>CHC Study on strategies for social relevance and community orien...
Case study – Medical Education in India (contd….) <ul><li>CHC study on medical curriculum reform through graduate feedback...
Case study – Medical Education in India (contd….) <ul><li>CHC report to Independent commission on Health in India (1998) r...
Case study – Medical Education in India (contd….) <ul><li>CHC Advocacy with Health University to introduce ethics in under...
Case study – Medical Education in India (contd….) <ul><li>CHC studies influencing medical education reorientation for Nati...
Case Study - Karnataka Task Force on Health and Family Welfare - 2001 <ul><li>Characteristics:  </li></ul><ul><li>Twelve m...
Case Study - Karnataka Task Force on Health and Family Welfare - 2001 <ul><li>Key Findings: </li></ul><ul><li>Corruption <...
Case Study - Karnataka Task Force on Health and Family Welfare - 2001 Research Study Outcome Review of externally aided pr...
Case Study - Karnataka Task Force on Health and Family Welfare – 2001 (contd….) Karnataka State Integrated Health Policy 2...
Case Study – People’s Tribunals and Health Watches People’s Health Movement initiated in 2000 (At National and State level...
Case Study – People’s Tribunals and Health Watches Case Study – People’s Tribunals and Health Watches
<ul><li>People’s Tribunals on Denial of right to </li></ul><ul><li>Health Care initiated by National Human </li></ul><ul><...
Global Health Watch - I Alternative World Health Report Global Health Watch – Alternative World Health Report Collecting a...
<ul><li>Global Health Watch – Alternative World Health Report </li></ul><ul><li>Collaborative project of PHM, GEGA, MEDACT...
<ul><li>www.sochara.org </li></ul><ul><li>www.phmovement.org </li></ul><ul><li>www.phm-india.org </li></ul><ul><li>www.glo...
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Strengthening Links Between Research And Policy

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Strengthening Links Between Research And Policy

  1. 1. Health Systems and Health Research Systems Strengthening the links between research and policy making: Perspectives from India Seminar: Fudan University, Shanghai, 4 th November 2007 Dr. Ravi Narayan, Community Health Advisor, Society for Community Health Awareness, Research and Action Bangalore – India.
  2. 2. India- An overview SOCHARA has worked with the 5 states indicated by red arrows Some indicators Population (in 2007): India 1,135,732,419 China 1,324,441,559 Area (in sq km in 2007): India: 3,287,590 China: 9,596,960 Per-capita GDP (in USD): India: 3100 China: 5600 Infant Mortality Rate (per 1000 live births) (UNDP 2005) India: 63 China: 30
  3. 3. Health Systems in India – An overview Central State District State Health Systems National Health Programs Academic/ Research NGO/CSO Private/ Corporate Non-health Traditional POLICY CHALLENGES: CENTRALIZATION VS. DECENTRALIZATION & COMPREHENSIVE VS. SELECTIVE
  4. 4. Health Research Systems in India – An overview Ministry of Health Center State Academic and research institutions CSO Network of researchers Research institutions ICMR, ICSR. Other Institutions Private sector NGO Sector Planning Commission State planning board Task Forces Consultants Steering groups LARGE NUMBERS; MULTIPLE PLAYERS; COMPLEX/ANARCHIC LINKS
  5. 5. <ul><li>Multidisciplinary professional resource network in Public Health/Community Health </li></ul><ul><li>Objectives include awareness building, community action, educational strategies, research and policy advocacy </li></ul><ul><li>Works with central and state governments; NGOs & CSOs; campaigns and people’s movements and international health agencies </li></ul>Society for Community Health Awareness, Research and Action (SOCHARA) www.sochara.org
  6. 6. <ul><li>Interactive/participatory research with pro-active policy advocacy </li></ul><ul><ul><li>Case study: Medical Education </li></ul></ul><ul><li>Multi-disciplinary task forces collecting qualitative and quantitative evidence </li></ul><ul><ul><li>Case study: Karnataka task force for Health and Family Welfare </li></ul></ul><ul><li>People’s tribunals and health watches </li></ul><ul><ul><li>Case study: People’s health tribunals (India) and Global Health Watch (Global) </li></ul></ul>Strengthening links between research and policy making - Mechanisms
  7. 7. Case study – Medical Education in India <ul><li>Medico Friends Circle reflections (1991) recommends: </li></ul><ul><li>Community oriented, Socially conscious, primary health care provider </li></ul><ul><li>Multi-disciplinary health analysis and collective societal solution </li></ul><ul><li>Political economy, ethics and value orientation </li></ul><ul><li>Medical teachers – ethics and value orientation and learning facilitation </li></ul><ul><li>Links with peripheral hospitals and community projects </li></ul><ul><li>Institution part of community health/ people’s health network </li></ul>
  8. 8. Case study – Medical Education in India (contd….) <ul><li>CHC Study on strategies for social relevance and community orientation (1993) </li></ul><ul><li>50 STRATEGIES IDENTIFIED IN </li></ul><ul><li>Improving pedagogy </li></ul><ul><li>Additional courses – Behavioral Sciences, Ethics, Rational Therapeutics, Management Health Education, Epidemiology, etc. </li></ul><ul><li>Skill Development </li></ul><ul><li>Moving beyond teaching hospitals </li></ul><ul><li>Transcending Compartmentalization </li></ul><ul><li>Promoting Self-learning </li></ul><ul><li>[ Source: Annals of Community-Oriented Education – Network of Community-Oriented Educational Institutions for Health Sciences, Vol 7, 1994] </li></ul>
  9. 9. Case study – Medical Education in India (contd….) <ul><li>CHC study on medical curriculum reform through graduate feedback (1993) </li></ul><ul><li>(50 GRADUATES WORKING IN PHC / PHI) </li></ul><ul><li>Skill development/independent decision making </li></ul><ul><li>Involvement in community health programs </li></ul><ul><li>Examination reform </li></ul><ul><li>Career guidance </li></ul><ul><li>Strengthening internship </li></ul><ul><li>Alternative systems of medicines, ethics, management etc </li></ul><ul><li>[ Source: Annals of Community-Oriented Education – Network of Community-Oriented Educational Institutions for Health Sciences, Vol 7, 1994] </li></ul>
  10. 10. Case study – Medical Education in India (contd….) <ul><li>CHC report to Independent commission on Health in India (1998) recommendations include among others: </li></ul><ul><li>Creative Autonomy for PHC / CH oriented experimentation </li></ul><ul><li>Public Health Capacity/Cadre building </li></ul><ul><li>Research on health policies, health systems and social determinants </li></ul><ul><li>Health team development for PHCs </li></ul><ul><li>People’s Health Movement to counter market orientation and promote HFA as a Right </li></ul>
  11. 11. Case study – Medical Education in India (contd….) <ul><li>CHC Advocacy with Health University to introduce ethics in undergraduate curriculum (1999) </li></ul><ul><li>Ordinance </li></ul><ul><li>“ The Doctor should be trained to analyze the ethical problems as they arise and deal with them in an acceptable manner. It is therefore recommended that teaching of Medical Ethics be introduced n Phase I and continued throughout the course including the internship period”. </li></ul><ul><li>Syllabus </li></ul><ul><li>Includes Introduction, perspectives, ethics of individuals, ethics of human life, ethics of family and society, death and dying, professional ethics, research ethics and ethical case work </li></ul><ul><li>RGUHS (1997-98) </li></ul>
  12. 12. Case study – Medical Education in India (contd….) <ul><li>CHC studies influencing medical education reorientation for National Rural Health Mission (2000) </li></ul><ul><li>EVIDENCE CONSIDERED included </li></ul><ul><li>CHC Studies especially graduate feedback (1993) </li></ul><ul><li>MFC Alternative Curriculum (Medical Education Re-examined) (1991) </li></ul><ul><li>And others…………. </li></ul>Refer: http://mohfw.nic.in/NRHM.htm
  13. 13. Case Study - Karnataka Task Force on Health and Family Welfare - 2001 <ul><li>Characteristics: </li></ul><ul><li>Twelve members from different sectors and disciplines (mostly non-governmental) </li></ul><ul><li>Fifty five participatory sessions </li></ul><ul><li>Nine commissioned research studies </li></ul><ul><li>Field-visits </li></ul><ul><li>Invited suggestions through press advertisements </li></ul><ul><li>Two year process with interim report and final report </li></ul><ul><li>Post-task force implementation committee </li></ul>
  14. 14. Case Study - Karnataka Task Force on Health and Family Welfare - 2001 <ul><li>Key Findings: </li></ul><ul><li>Corruption </li></ul><ul><li>Neglect of public health </li></ul><ul><li>Distortions in primary health care </li></ul><ul><li>Lack of equity process </li></ul><ul><li>Implementation gap </li></ul><ul><li>Need for ethical imperative </li></ul><ul><li>Human resource development neglected </li></ul><ul><li>Cultural gap and challenge of pluralism </li></ul><ul><li>Ignoring political economy </li></ul><ul><li>Exclusivism rather than partnerships </li></ul><ul><li>Inadequate policy research…. </li></ul>
  15. 15. Case Study - Karnataka Task Force on Health and Family Welfare - 2001 Research Study Outcome Review of externally aided projects in context of integration and sustainability Integrated HNP policy and project (Study quoted in CMH/Sach’s Report for WHO ) Regional disparities in health and health care service State projects with preferential focus on disadvantaged districts Does Karnataka need more medical colleges Task force and health university recommend moratorium on medical college to counter commercialization
  16. 16. Case Study - Karnataka Task Force on Health and Family Welfare – 2001 (contd….) Karnataka State Integrated Health Policy 2003 (Drafted by SOCHARA) Incorporating many key recommendations of the task force and passed through several committee’s and cabinet so that recommendations become part of state policy unaffected by political changes and other influences
  17. 17. Case Study – People’s Tribunals and Health Watches People’s Health Movement initiated in 2000 (At National and State levels in India) “ Strong countervailing movement initiated by health and development professionals and activists, consumer and people’s organizations (over 20 networks) to bring health care and medical education and their right orientation high on the political agenda of the country and to ensure that the health policy choices are led by people’s health needs, not market factors” - Independent Commission on Health in India, 1999
  18. 18. Case Study – People’s Tribunals and Health Watches Case Study – People’s Tribunals and Health Watches
  19. 19. <ul><li>People’s Tribunals on Denial of right to </li></ul><ul><li>Health Care initiated by National Human </li></ul><ul><li>Rights Commission & PHM- India (2004 on-wards) </li></ul><ul><li>Lessons learnt </li></ul><ul><li>Peoples evidence strong on corruption, gender discrimination, social exclusion, stigma and system defaults </li></ul><ul><li>Structural issues must be documented as key complement to individual experience </li></ul><ul><li>True Government – Civil Society Partnership </li></ul><ul><li>Strong bottom-up pressure for policy change (leading to initiation of Community Planning and Monitoring of Health Services as an integral part of National Rural Health Mission in 2006) </li></ul>Peoples voices at national level People’s health tribunals in India Case Study – People’s Tribunals and Health Watches
  20. 20. Global Health Watch - I Alternative World Health Report Global Health Watch – Alternative World Health Report Collecting and interpreting evidence for policy change 125 academics/ researchers collate evidence and write contributory chapters for the first alternative world health report released on 29 th July at PHA 2 Case Study – People’s Tribunals and Health Watches
  21. 21. <ul><li>Global Health Watch – Alternative World Health Report </li></ul><ul><li>Collaborative project of PHM, GEGA, MEDACT-UK and many others </li></ul><ul><li>Strong on social determinants </li></ul><ul><li>Advocacy document launched worldwide </li></ul><ul><li>Latin American document also evolved through a local consultative process </li></ul><ul><li>Outcomes </li></ul><ul><li>Right to Health Campaign starting in many countries </li></ul><ul><li>Country level reports on health situation </li></ul><ul><li>Active civil society feed back to WHO commission on Social Determinants of Health </li></ul>Global Health Watch Alternative World Health Report Case Study – People’s Tribunals and Health Watches
  22. 22. <ul><li>www.sochara.org </li></ul><ul><li>www.phmovement.org </li></ul><ul><li>www.phm-india.org </li></ul><ul><li>www.globalhealthwatch.org </li></ul><ul><li>http://mohfw.nic.in/NRHM.htm </li></ul>References

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