department of health services provision - world health organization - geneva elena varavikova,...

Department of Health Services Provision - World Health Organization - Geneva

Elena Varavikova, scientist,Department of Human Resources for HealthEvidence and Information for Policy

Health Research for the Population Health improvement – building capacities


Health research - definitions

"Research is a system involving people, Institutions and processes. Its pursuit depends on systematic analysis, creativity and exploration"

(Comission on health Research for Development, 1990)


Challenges for Kazakhstan

MDG by 2015 State Program on reform and development of

Public Health of the Republic of Kazakhstan

2005-2010 Population Health analysis and improvement

(LE, Infant & maternal mortality, CVD; etc) Monitoring and Evaluation of the health system Research, education and training


Working in the Public Health Field

Survey methods Evidence-based recommendations, info. Continuous education Planning Working with expert advisory group Team building Maximising health gain with available resources Working conditions


Who are doing the job of population health analysis and evaluation? Education and Training?

MOH ? National Public Health Institute? Health leaders? Politicians? Professional Associations? NGO's, Donors? Who are working in this area and who prepared

them? System of continuous education – available?


WHO Knowledge for better Health - " know-do " gap

Research is an investment, not a cost A broader, more inclusive view of health research is

needed Research should be applied to improve health equity Research must be conducted according to universal ethical

standards Knowledge derived from research must be accessible to all Civil societyhas a vital part to play in setting resear


Acute care hospital admissions per 100

Source: WHO/Europe, HFA Database, January 2005

Kazakhstan

Kyrgyzstan

Russian Federation

Tajikistan

Turkmenistan

Uzbekistan

EU


Live births per 1000 population

Kazakhstan

Kyrgyzstan

Russian Federation

Tajikistan

Turkmenistan

Uzbekistan

EU


Autopsy rate in %, for hospital deaths



Kazakhstan

Kyrgyzstan

Russian Federation

Tajikistan

Turkmenistan

Uzbekistan

EU

SDR, diseases of circulatory system, 0-64 per 1000000


SDR, cerebrovascular diseases, 0-64 per 100000


SDR, trachea/bronchus/lung cancer, 0-64 per 100000


Kazakhstan

Kyrgyzstan

Russian Federation

Tajikistan

Turkmenistan

Uzbekistan

EU


Role of PH ProfessionalRole of PH Professional

To study, understand and report on the scale of the health situation and to raise public and political awareness

To interpret patterns of health and morbidity e.g smoking, alcohol, social dislocation

To advise on what should be done, drawing on best available evidence of effectiveness of interventions from different settings e.g. folic acid, community vs. hospital care

To monitor the impact of new policies, adapting them for changing circumstances


Understand Social Determinants of Disease and OutcomesUnderstand Social Determinants of Disease and Outcomes

Lifestyle issues e.g. smoking, diet, exercise Societal issues e.g. unemployment, family income Complex mechanisms e.g. transition and self image Widening social and regional inequities Crucial roles of education, pensions, social policy,

political economics, health policy Partnerships to deal with complexity Analysis and monitoring What can the health system do to alleviate the negative

results of individual and societal states?


Political and Societal ContextPolitical and Societal Context

Shift toward market economy Reduced job and societal security Administrative decentralization (vs decapitation) Undervaluing of health e.g. health expenditures as %

GDP under 5% vs. 7-9 % in industrial countries Reduced role of the state Switch from Semashko to Bismarckian models Stress on individual responsibility Role of the hospital oriented health system vs. shift to

community oriented system


What’s outside of the SPH’s walls? Globalisation; social and economics instability Changing role of the National Health Systems Health Threats: HIV/AIDS, TB, Malaria ... Macroeconomics and Health 10/90 and Health Research Evidence-based decision-making


What are objectives of KSPH ?

Centers of excellence – training, research, service International standards and participation Academic independence i.e. not a function of state Attractive to students and stakeholders Sustainability Culture of quality Acceptance by graduates and faculty Accountability and reward - not by hours but program

and results Internal and external peer review


Potential Contribution of Potential Contribution of Schools of Public HealthSchools of Public Health

Train people (skills and competencies) to:Train people (skills and competencies) to: Analyze health system and PH problemsAnalyze health system and PH problems Develop evidence-based policiesDevelop evidence-based policies Assist governments in re-alignment of health prioritiesAssist governments in re-alignment of health priorities Work with public and private sectorWork with public and private sector

Research and develop tools to deal with new issues, e.g. Research and develop tools to deal with new issues, e.g. globalization, communications technology, internet globalization, communications technology, internet

Continuous professional and public educationContinuous professional and public education Develop policy, programs, models and actions driven by Develop policy, programs, models and actions driven by

national and community needs (e.g. poverty and national and community needs (e.g. poverty and inequity reduction)inequity reduction)

Create a demand for professionalism in public healthCreate a demand for professionalism in public health


Role of Research in SPHsRole of Research in SPHs

Set standards of evidence from past and current Set standards of evidence from past and current international experienceinternational experience

Identify avoidable morbidity/mortality in individual Identify avoidable morbidity/mortality in individual and population healthand population health

Identify individual and societal risk factorsIdentify individual and societal risk factors Explore ways to prevent disease and promote healthExplore ways to prevent disease and promote health Find the ways of improving primary prevention and Find the ways of improving primary prevention and

delivery of health services (efficiency, effectiveness, delivery of health services (efficiency, effectiveness, evidence-based)evidence-based)

Promote quality in management in health systemsPromote quality in management in health systems


Research Capacity development

Careful selection of trainees Capable scientific leadership Continuity of research funding Good equipment Supplies in the institutions including

communication facilities


Research in SPHsResearch in SPHs

Publications in local and international peer reviewed Publications in local and international peer reviewed scientific journals scientific journals

Develop culture of peer review and a selfDevelop culture of peer review and a self--critical critical attitudeattitude (Research Forum) for students and faculty (Research Forum) for students and faculty

Disseminate findings to those who can benefit Disseminate findings to those who can benefit If in national language, abstract in English inviteIf in national language, abstract in English invitess

comment and criticism from a wider audiencecomment and criticism from a wider audience If funding of a SPH is tied to teaching hours, need to If funding of a SPH is tied to teaching hours, need to

provide incentives and time for active research to be provide incentives and time for active research to be valued and rewarded valued and rewarded


ConclusionConclusion

High mortality and morbidity from preventable High mortality and morbidity from preventable diseases cannot be addressed without training diseases cannot be addressed without training large numbers of public health professionals large numbers of public health professionals

Need for research Need for research impossible overestimate impossible overestimate

Attention to the cadresAttention to the cadres

Needs time, resources, international support, Needs time, resources, international support, and adaptation from successful experience to and adaptation from successful experience to local circumstanceslocal circumstances

department of health services provision - world health organization - geneva elena varavikova,...

Documents

health evidence

better health

health leaders

health system research

policy health research

health equity research

population health improvement

development of public