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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
Department of Health Services Provision - World Health Organization - Geneva
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)
Department of Health Services Provision - World Health Organization - Geneva
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
Department of Health Services Provision - World Health Organization - Geneva
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
Department of Health Services Provision - World Health Organization - Geneva
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?
Department of Health Services Provision - World Health Organization - Geneva
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
Department of Health Services Provision - World Health Organization - Geneva
Acute care hospital admissions per 100
Source: WHO/Europe, HFA Database, January 2005
Kazakhstan
Kyrgyzstan
Russian Federation
Tajikistan
Turkmenistan
Uzbekistan
EU
Department of Health Services Provision - World Health Organization - Geneva
Live births per 1000 population
Kazakhstan
Kyrgyzstan
Russian Federation
Tajikistan
Turkmenistan
Uzbekistan
EU
Department of Health Services Provision - World Health Organization - Geneva
Autopsy rate in %, for hospital deaths
Department of Health Services Provision - World Health Organization - Geneva
Source: WHO/Europe, HFA Database, January 2005
Kazakhstan
Kyrgyzstan
Russian Federation
Tajikistan
Turkmenistan
Uzbekistan
EU
SDR, diseases of circulatory system, 0-64 per 1000000
Department of Health Services Provision - World Health Organization - Geneva
SDR, cerebrovascular diseases, 0-64 per 100000
Department of Health Services Provision - World Health Organization - Geneva
SDR, trachea/bronchus/lung cancer, 0-64 per 100000
Source: WHO/Europe, HFA Database, January 2005
Kazakhstan
Kyrgyzstan
Russian Federation
Tajikistan
Turkmenistan
Uzbekistan
EU
Department of Health Services Provision - World Health Organization - Geneva
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
Department of Health Services Provision - World Health Organization - Geneva
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?
Department of Health Services Provision - World Health Organization - Geneva
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
Department of Health Services Provision - World Health Organization - Geneva
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
Department of Health Services Provision - World Health Organization - Geneva
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
Department of Health Services Provision - World Health Organization - Geneva
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
Department of Health Services Provision - World Health Organization - Geneva
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
Department of Health Services Provision - World Health Organization - Geneva
Research Capacity development
Careful selection of trainees Capable scientific leadership Continuity of research funding Good equipment Supplies in the institutions including
communication facilities
Department of Health Services Provision - World Health Organization - Geneva
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
Department of Health Services Provision - World Health Organization - Geneva
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