That health, education and various other public services are distributed unfairly is not new for human societies; the level of unfairness however appears to be on the increase. This is indeed counter-intuitive, given the last few decades’ strides in economic progress and even improved average lifespan and improving access to health globally. Despite widespread feeling that inequalities in health or healthcare distribution is explained by chance or by other proximate explanations such as distance or wealth, the “causes of the causes” are invariably lying within social factors (see my recent TedX talk on health as a matter of chance, or of choice). Continue reading
The last few decades have seen a proliferation of research in the domain of health policy and systems research (HPSR). Major technological advances in medicine and various healthcare innovations have little chances of succeeding if robust country, provincial and local health systems are lacking. Continue reading
I am rejuvenating a note I had started a few months back on reading an article on doctor availability in rural areas by Krishna Rao in The Hindu a few dasy back.
Chikkanayakanahalli taluka hospital in Chikkanayakanahalli taluka in Tumkur district. Being a taluka hospital, it is supposed to cater to the hospital needs of 219,000 people in this taluka. Continue reading
The story was tragic. A Tuberculosis patient from India who died because the system which was expected to provide for his treatment failed to deliver… and then the dessert arrived.
A lot has been said, something has been tried and many reports have been published about the huge North-South divide seen in the world today. The resource-rich, but economically poor global South continues to reel under socio-economic, political and apparently scientific poverty (if research publications are any index of science!). We, the global South have the natural resources, human resources and such yet continue to reel under severe problems of hunger, malnutrition, lack of education and poor health care. Research outputs from countries like lndia continues to be poor in quantity and quality – Dandona and colleagues found that a mere 3% of the already dismal health research from India was on public health.
Many global initiatives have brought this up. The Global Forum for Health Research popularised the now famous, 10/90 gap in research – 90 % of health research focussing on 10% of the world’s health problems. Initiatives such as the Global Fund and WHO TDR tried to shift focus to the world’s major health problems – Tuberculosis, Malaria and neglected tropical diseases. Much rhetoric and some action has gone into fight against the Pareto gap in health.
One of the most sincere of such attempts is the small and silent steps that the Institute of Tropical Medicine, Antwerp (ITM) has been taking with the support of the Belgian Government. The school, little known in India has been popularising the agenda of ‘switching the poles’ – trying to put the Southern nations in the drivers’ seat. One of the initiatives under this was the ‘Emerging Voices’ initiative – an effort to choose 52 emerging voices in health research and help break the monopoly of the usual suspects at global fora. ITM provided training in research writing, presentation skills and science communitcation during a run up to the grand WHO symposium on health systems research in Montruex, Switzerland. We, emerging voices received inputs from senior faculty at the Institute as well as language coaching from Linguapolis, the language school of the University of Antwerp. It was a brilliant idea that sought to choose researchers from the South and present new ideas at the international forum.
My essay on Public-private Partnership in primary health care tried to present an arguement for using health systems research to understand the conditions under which internventions work and not go in for grand scaling up, the way things happen these days in policy making. I was indeed happy to have been chosen to speak at the event in Montreux. But, the most interesting outcome of the entire Emerging voices initiative was the fact that a school in the North made a sincere attempt to support researchers from the South and provided an environment for greater collaboration between Southern researchers.
Research in health today is dominated by researchers from the richer countries. While research institutions in the South grapple with poor research budgets, poor teaching and skills and the lack of a ‘culture’ of research, most Northern institutions have had the benefit of long years of colonisation and Western science and greater budget allocations. Even when global research grants are given, the agenda is often dominated by the richer countries. In ITM, many of us emerging voices saw a genuine commitment to shift gears.
At Montruex was waiting for us a gala event. It was a gather of over a 1000 health researchers from all over the world. It was quite a well planned symposium with sometimes over 10 parallel sessions. Ranging from methods in health systems research (complexity, action research) to small gatherings of activists from the people’s health movement, the symposium was quite a diversity of actors in international health. The venue was a bit strange of course – a symposium focussing on the problems of lack of even basic access to health care being held in Montreux, Switzerland was quite an irony – in this short piece, ‘WHO Pokerface’, Meena Daivadanam, one of the emerging voices raises this concern on a blog here. We even brought this up in our own pecha-kucha presentation at the closing plenary of the symposium, when 3 emerging voices (Lalit Narayan, Aida Zerbo and Wilfred Gurupira) presented the take-home message of the emerging voices to the entire symposium. Some uncomfortable, yet important questions to the international health research community.
A great initiative by ITM, Antwerp. I hope many more schools and institutions in the North will recognise the importance of supporting south not merely with money but with building capacity and commitment. Thanks ITM for being sincere, committed and passionate about putting Southern researchers in the drivers’ seat.
NB: Special thanks to An Applemans, David Hercot, David Hendrickx, Kristoff Decoster, Jos Assayag, Wim Van Damme and several others at the Emerging Voices Secretariat and department of public health at Institute of Tropical Medicine, Antwerp