COHESION @ ICRD

At the beginning of September 2017 in Bern the 4th International Conference on Research for Development (ICRD) was held. The aim of the conference was to present “visionary contributions that will enhance transformations towards sustainable development in countries of Africa, Asia, and Latin America.” (www.icrd.ch)

COHESION was of course present at this important event. COHESION co-organised two sessions on partnerships with the Council on Health Research for Development (www.cohred.org) and Commission for Research Partnerships with Developing Countries (www.kfpe.ch). Maria Amalia Pesantes from the COHESION Team in Peru was a panelist during a session on increasing equality in partnerships. These sessions on partnerships highlighted a variety of challenges in establishing partnerships, but also tools developed to help address these and the role funders can have in helping facilitate partnerships. One interesting aspect was thinking about the process of partnerships and how there are “Hard elements”, such as shared vision, setting the agenda together, fairness and sharing of process and capacity building. In parallel “Soft elements”, such as trust, respect, being open and cultural differences are equally important. Both hard and soft elements are essential to ensure success, but require different approaches to be established. It was interesting to reflect on these as COHESION as a project and a partnership evolves.

Silvana Perez Leon also from the Peru Team won a grant to present some of her work at the conference. During the session “Building transformative partnerships between health services and communities as a means to advancing the Agenda towards Sustainable Development: A pathway forward”, she presented her experience engaging with primary health care workers and community members in the COHESION project. She pointed out some of the enablers and challenges the Peru team had in building transformative partnership. Lessons from this session were that the WHO is preparing a community engagement framework that can be used for projects like COHESION. Recommendations were also that as a project we should systematically document our process of engagement which can later be used as evidence for other initiatives.

Besides COHESION’s direct contribution to the content of the conference, this was a unique opportunity to link the work being done in Mozambique, Nepal, Peru and Switzerland to the wider development agenda. A message that was mentioned frequently was the unfinished Millennium Development Goals (MDG) Agenda. Another element discussed widely was the link between economic development and health in parallel to progressing political processes and the role of communities and civil society in this.

These aspects are interesting in thinking about COHESION’s approach in dealing with diseases of poverty (NTDs) and diseases that are intimately linked to development (NCDs) by focusing attention on communities to develop interventions.

Being based in Switzerland it also emphasised the importance of Switzerland as a donor, funding such projects as the r4d scheme as well as that the Sustainable Development Goals (SDG) unlike the MDGs are for all countries and not just low income countries. This requires a change in approach from one of high income settings coming with solutions to MDG related problems to, as stated in SDG 17, partnership. The SDGs are integrated and inseparable in that many of the goals are interlinked.

The banner at the entrance of the conference had the following three words:
– Evidence
– Engagement
– Policies

Thinking about these three words and the SDGs, COHESION is increasing the evidence base in terms of burden of NCDs and NTDs at policy, health system and community level. To address these challenges, COHESION by engaging local stakeholders will develop innovative interventions to address these challenges. Based on the COHESION research to date the issue of policies is of concern in that although many aspects of NCDs and NTDs are being addressed in health systems through the delivery of care, but policies are lacking to help guide these responses and involve communities. From a COHESION perspective, a fourth element to the ICRD list would be implementation. In that evidence, engagement and policies without implementation are meaningless. As COHESION moves from formative research, engaging local stakeholders and understanding global and national policies, its next step will be to implement innovative interventions to contribute to the achievement of the SDGs.

Research Assistant from Peru awarded scholarship for ICRD

The fourth edition of the International Conference on Research for Development (ICRD), will be co-hosted by the Swiss Programme for Research on Global Issues for Development (r4d programme) and by the University of Bern’s Centre for Development and Environment (CDE). The event will take place 5-8 September 2017 in Bern, Switzerland, with the theme “Evidence. Engagement. Policies.”

The ICRD offered young researchers the opportunity to apply for financial support to participate in the conference. Silvana Pérez León, COHESION Research Assistant in Peru, applied and was awarded the scholarship.

“I thought this was a great opportunity to build a proposal and show some of the work the COHESION project has been doing in Peru. The session that captured my attention was ‘Building transformative partnerships between health services and communities as a means to advancing the agenda towards sustainable development: a pathway forward’; because one important objective of COHESION is to build interventions in primary health care services that include the participation of the community.” – Silvana Pérez León

Silvana’s proposal to the ICRD included information gathered during the engagement and formative studies with health workers and the communities. This process enabled the Peruvian team to understand and acknowledge the needs of different stakeholders and to start thinking about how COHESION could design interventions that build transformative partnerships between health services and communities.

Silvana will be a panelist at ICRD on September 6, showing some of the work the Peruvian team has been developing in the past months.

Silvana Pérez León presenting at the ICRD.

 

Silvana Pérez León collecting data that informed her presentation at ICRD.

Seminar in Peru: Health Policies and Systems Research

The CRONICAS Center of Excellence in Chronic Diseases is sharing knowledge, building capacity and mutual understanding of health Policy and Systems Research.

Given the growing emphasis on health systems research and the role of health policy in the health of populations, the Peruvian team of COHESION, CRONICAS recently held a seminar on the topic.

Here is an overview of what took place and what the main and most important messages were:

On July 03 2017, the Institute of National Health (INS) and CRONICAS Center of Excellence in Chronic Diseases with the support of The Alliance for Health Policy and System Research- WHO, held the seminar “Health Policies and Systems Research” at the headquarters of the INS.  The objective was to show and discuss a new area of research that can be used for the implementation of policies.

Dr. Hans Vasquez from the “General office of Research and Technology Transfer” opened the seminar and stressed the importance of moving forward from diagnostic research to doing research that can have a bigger impact on health. In countries like Peru there is little research on policies, health systems or implementation.

The first presentation was provided by Nhan Tran, manager of “The Alliance for Health Policy and Systems Research (AHPSR)”. He said that the current challenge is to ensure health interventions are effectively integrated into health systems and are designed to be scaled up in different contexts. He pointed out that one of the reasons why implementation is so difficult is because implementation is about change (asking organizations to behave differently, people to do things differently, etc.). That is why it is important to think implementation as a process of change. Finally, he emphasized three main important shifts on how to do implementation: 1) applying a more systems perspective, 2) thinking about research as part of the implementation research, and 3) having local investment in implementation.

(Left to right Dr. Hhan Tran and Dr. Hans Vásquez; picture from INS https://goo.gl/iwfkAt)

The next two presentations were from representatives of the public sector, Dr. Manuel Catacora Villasante from the “Institute of assessment in technologies in Health and Research” of the Social Security; and Bio Gisely Hijar Guerra from the “National Center of Public Health-INS”. They talked about the prioritized research subjects of their institutions, gave some examples of research being developed and pointed out some opportunities of funding.

The fourth presentation was given by Dr. Ludovic Reveiz from the Pan American Organization, where he explained how there is still too little information on how to do implementation research in policies. He showed the work the program iPIER is developing in Latin America and the Caribbean, which aims to facilitate improvements in program implementation through implementation research. An important part of this program is a workshop where the grant recipients receive a basic understanding of the research methodologies in implementation research.

The fifth presentation was from Dr. Fernando Llanos of the Universidad Peruana Cayetano Heredia. He talked about his research in health systems at primary care and universal coverage. He explained some conceptual frameworks, the methodology of the study and some final conclusions. He highlighted two important conclusions; first that before thinking in primary health care, there should be a clear definition of what is considered primary health care in Peru, and second, that talking about universal coverage meant to think of the system as a whole, because in the Peruvian context there are several subsystems.

Mg. Gerardo Seminario of “Salud sin Limites” gave the final presentation where he spoke about the process of making an agenda for public policies for the health of indigenous populations in Peru. He pointed out that a policy agenda is not necessarily a rational decision but derives from other factors like power roles, negotiations, institutional frames, etc. The making of an agenda consists on the concurrence of 4 factors: a problem, a possible solution, stakeholders and a window of opportunity. He concluded that the policies for the health of indigenous populations is still fragile, because the response for intercultural health is accepted but only on the surface, because the network of experts is not consolidated, because politicians change frequently as do their interests, because the vertical structure of the health system does not facilitate an intercultural health, and because the window of opportunities is narrowing.

(Picture from INS https://goo.gl/iwfkAt)

At the end of the seminar there were two panel discussions. One, about the priorities of research policies and health systems, included the participation of Dr. Maria del Carmen Calle Dávila (General Directorate of Strategic Interventions in Public Health) and Dr. Hans Vasquez (INS). The second panel was about funding opportunities for research in policies and health systems, and included Dr. Franco Romani (INS) and Dr. Alexander Tarev (General Directorate of Strategic Interventions in Public Health). The discussions brought to our attention the efforts of the public sector to do research, and though these efforts are few and recent, the road is being build. There is still the need that the research community meets the demands of the public sector. In that sense it is necessary that the public sector opens more opportunities where policy makers and researchers can encounter each other.

This seminar was a good opportunity for the dialog between the research community, policy makers and civil organizations. For the COHESION team, it was a good moment for engagement and to gain an update of the research being done in in health policies and systems.

CRONICAS and Health Systems Research:

At CRONICAS Center of Excellence in Chronic Diseases there have been past and ongoing research projects related to the assessment of health systems. Through 2012-2013 the project “Barriers” financed by the AHPSR, piloted for the first time in Peru a research implementation manual for the evaluation of healthcare systems’ responses to chronic non-communicable diseases. Currently the COHESION project has as objective to improving the health system response for attending the double burden of Noncommunicable and Neglected Tropical Diseases. Initiatives like these are in the path to look for solutions for the current health issues the health systems face.

Additional information:

Engagement activity with stakeholders at the macro level of the health system in Lima- Peru

Summary: Engagement activity with stakeholders at the macro level of the health system in Lima- Peru

On May 3, the COHESION project in Peru held a meeting with stakeholders, where stakeholders related to the health sector and the diseases related to the project (diabetes, hypertension and neurocysticercosis) were invited. The purpose of the meeting was to present the project, create links with different institutions and receive inputs or recommendations for the project.

The meeting was attended by members of the COHESION project in Peru, part of the COHESION team from Switzerland, public officials from both the Ministry of Health and the Superintendence of Health, as well as some civil society organizations such as the Diabetes Association of Peru and the Peruvian Federation of rare diseases.

The meeting began with the words of welcome from Jaime Miranda, Director of “CRONICAS center of excellence in chronic diseases”. During his welcoming he remarked the intention of the meeting to carry out a co-creation process between the COHESION project and the assistants, to think together ways of improving the health system, especially in the attention given in the primary health care.

Following, David Beran principal investigator of the COHESION project made a presentation of the project COHESION (in Spanish). He explained the linkage between the project with the Millennium Development Goals and the Sustainable development objectives. He also pointed out important qualities of the project like being a multidisciplinary and multi-country team. Finally he explained the different stages that the project has carried out and the stages to come in the next years.

Subsequently, the words were given by María Kathia Cárdenas, coordinator and researcher of the COHESION project and at CRONICAS Center of Excellence in Chronic Diseases. During her presentation she explained the COHESION project in the Peruvian scenario. She specified the project is being carried out in the region of Piura, in the health posts of Sicacate and Pingola, located in the districts of Montero and Ayabaca respectively. During this presentation it was also specified two of the studies that the project is carrying on, the evaluation of policies and the health system assessment. She explained details of each study and the different levels of analysis. Furthermore, she also explained the methodology that is being implemented based on the manual “How to investigate access to care for chronic noncommunicable diseases in low and middle income countries” (2012) from the WHO, and she also explained the activities that were already performed at the community level such as interviews with patients, health workers, head of facilities, among others.

Next, María de los Ángeles Lazo, researcher of the COHESION project and at CRONICAS Center of Excellence in Chronic Diseases, detailed the steps that will follow the project in the next months to involve the stakeholders at the macro or national level. She explained to the participants the important need of their support and expressed the intention of the project to involve them actively in the process, as well as with other key stakeholders. It was also specified that in the short term the COHESION project will be contacting them to have personal interviews, to know their opinions on the health systems facilitators and barriers.

Finally the discussion was opened to the attendees so they could express their opinions, comment or question of the project. This final part was moderated by María Amalia Pesantes, coordinator and researcher of the COHESION project and at CRONICAS Center of Excellence in Chronic Diseases. Some of the most important arguments and recommendations are detailed below:

  • To include the perspective of caregivers. It is important the health system recognized their task, not only in a financial support, but also to be trained in the care of the patients and to consider the importance of psychological support for the caregivers, who were also called “acompañantes” (companions).
  • Developing engagement with key stakeholders such as public officials and political representatives is a long-term endeavor.
  • It is necessary to establish relations with the regional health directorate in Piura. This entity is the responsible of providing the health service, while the Ministry of Health is in charge of regulating and monitoring. It was also suggested to interview the head of the department of Planning and Budget and Human Resources, and to include the Regional Government, who has also responsibilities related to health, poverty, access to water and sanitation.
  • It was also highlighted the important role played by community agents in the health system.
  • It was acknowledged the low ability of the Ministry of Health to communicate strong messages. Furthermore, civil society lack of relevant information about diseases, especially the most neglected population.
  • Past experiences on training diabetes educators were shared and it was noticed that one of the main difficulties in the training of health workers was the high rotation to other health establishments, and this should be taken in to account for the project.

Participants:

COHESION Team (Switzerland):

  • David Beran
  • Sarah Lachat
  • Suzanne Suggs
  • Nathaly Aya Pastrana

COHESION Team (Peru):

  • Jaime Miranda
  • Maria Kathia Cardenas
  • Maria Amalia Pesantes
  • Maria de los Angeles Lazo
  • Charlotte Darwis
  • Rosa Salirosa
  • Silvana Perez Leon

Participants:

  • Jorge Calderón (President of the Diabetes Association in Peru)
  • Luciana Bellido Boza (Representative of Intendance of Research and Development – SUSALUD)
  • Jorge Ferrandiz (Executive Director of the Department of Prevention and Control of Noncommunicable, Rare and Orphaned Diseases)
  • Maria Lourdes Rodriguez (President of Hecho con Amor-asociation of multiple sclerosis in Peru and President of the Peruvian Federation of rare diseases)
  • Lilliam Lindley (Representative of Hecho con Amor-asociation of multiple sclerosis in Peru and President of the Peruvian Federation of rare diseases)