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Strengthening Health Research Capacity in Developing Countries for Equity in ESRD Prevention

Explore key challenges and strategies in improving health systems for equitable access to ESRD prevention and treatment in developing countries.

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Strengthening Health Research Capacity in Developing Countries for Equity in ESRD Prevention

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  1. Strengthening Health Research Capacity in Developing Countries for Equity in ESRD Prevention Chitr Sitthi-amorn, MD PhD Institute of Health Research February 2004

  2. Health Research Needs for Equity in ESRD? • Quantify Magnitude of the Problems • Predictable, Preventable • Equity of access to care by social groups • Tap Unprecedented opportunities • Screening & early treatment for DM, HT • Coping with widening disparities of access to care by the disadvantages (available, affordable, acceptable). • Dealing with capacity constraints

  3. ESRD in Asian-Pacific Regions • Prevalence of ESRD linked to funding of dialysis (prevalence = 4.2 to 17.3% between 1998 to 2000). • PD = 3.9 to 81% of dialysis population. • Transplantation rate: 3.1 per million to 32 per million Semin Nephrol. 2003; 23: 107-14)

  4. Objectives of HR for ESRD • Improve health & quality of life. • Promote evidence based actions to improve equity of access to prevention, early treatment, rehabilitation • Efficacy, Effectiveness, Efficiency.

  5. Key Challenges • Value of Health Systems and Health Research System: • Access: equity or ability to pay • Country Focus & Regional/Foreign support: • Local Trust: Actors, Issues, Settings. • Key Research Areas: Capacity, Facilities, Commodities, Knowledge

  6. 1. Value: Equity & Ability to Pay

  7. Key Challenges 2: Country Focus • Country Focus: • Actors:Academic, Politics, Providers, People, Public, Private • Issues: Creation of awareness; prevention; screening and early treatment; prevent progression of CKD; Rehabilitation • Setting: Resource constraint • Regional & Foreign Support:

  8. Strategies to Enhance Country Focus: Research for Equity • Promotion of Needs for evidence based action • Prime Movers interactions with actors • Knowledge for System management towards EB actions • Capacity strengthening • Networking

  9. Strategy: Promotion • ESRD is preventable and predictable • Awareness & dealings with local belief • Multi-faceted & Multidisciplinary actors • Risk groups: • NCDs: DM, Hypertension, family history of ESRD; renal and bladder stones • Infection: strep; HIVAN; hepatitis • Lifestyle: Heroine, smoking, salt, obesity

  10. Knowledge for Use by Champions Knowledge: Problem, New advances, Action Economic & Social Impact Champions Social Process Political Process

  11. System Management • Actors: Public, private, academic, industry, NGOs, and the people • Multi-level Causation & Intervention: • Policy • Infrastructure & Social Norms • Awareness, Behavior and lifestyles • Screening, Early TRT, TRT of CKD, ESRD

  12. Capacity: Supply Side 1 • Knowledge: Individual & Institution • Generation: Minority under-represented; biomedical sciences; clinical sciences; socio-economic impact; health system performance • Translation (VDO) >> Access: Geography; Affordable; Acceptable • Application: New nephrologists; Task based training • Monitoring and Evaluation

  13. Capacity: Supply Side 2 • System leadership & management: • Stewardship; Management; Leadership • Partnership: Negotiations; teamwork; IEC • Resource mobilization • Understanding & upholding ethics • Models: access to services and Drugs • Research:Clinical Trials, Clinical & biomedical Research: PURE, H5N1, malaria

  14. Capacity: Demand Side • Research Users: • Policy makers; Practitioners; Public & Communities • Potential Research funder • Development Agencies • Investors: Pharmaceuticals & Private Hospitals. • Corporates, Media, Other Programs.

  15. Capacity Development & Retention • Development • Strategic Objective for sustainability • Significant Research cum Capacity Dev • Individual & Institutional: Matched • Strategic research network Linkage • Network grant competition: • Small grant mentorship program • Retention: • Environment; Network; Volunteerism

  16. Networking & Partnership(Components of Partners) • Public Sector: Inter-government or Government; Research network; Mentorship network • Civil Society: Academics, NGOs, Philanthropies, ‘Not-for-profits' • For-Profit Sectors: Drugs & 'Biotech' companies, private hospitals, etc • Intended Beneficiaries: people

  17. Principles of Partnership • Decide on the objective together • Build up mutual trust • Share information: develop networks • Create transparency • Monitor and evaluate the collaboration • Apply the results • Share benefits • Increase capacity and personal development • Build on the achievements

  18. Monitoring Partnership • Agreement needed, 'good intention' not enough • Who has the best claim of 'moral high ground'? Who assesses whom? To assess partners or partnerships? • Practicality: Are guidelines practical? Do we know what works best for every situation? Will they stifle new ventures? • Self-Assessment might be more useful

  19. Key Research Areas • Research to enhance responsiveness of health systems • Models for efficient & effective care for ALL • Risk management in unique groups • Model to improve prevention • Clinical trials

  20. Key Research 1: Enhancing Health System Responsiveness • Knowledge to Enhance System Capacity • Financing & Inter-related Market • Organization for Optimal Care; referrals; public; private • Rules for incentives for providers and users of health systems • Effective Engagement in Political & Social Processes

  21. Problems with Unprepared Response: e.g., Social Insurance Health professional etiquette: • Setting artificial price • Corruption: • Referral of rich patients to private clinics and use government facilities to give services to the rich but collection of fees at private clinic Two tier health system

  22. Knowledge to Enhance Responsiveness What & How to Finance? • Inter-related Market:finance, human resource plan, facilities,drugs, education • Tools & their Linkages • Communication and Consensus: - Goals: Needs versus Rights - Goals: Social harmony vs Prosperity - Allocation: Budget versus Price - Voice from the People - Choice of more enlightened public

  23. How do we organize Optimal Care Organize Service Delivery: Money does not produceservice. It goes through an organization: • Role of different ministries - Protect the weak; Quality; Information; Targeting, Monitoring and Supervision. • Public, private and Pharmaceuticals: - Reform of civil servants - Competition versus partnership - Mentality, Language, Trust • Political commitment

  24. Management, Regulation and Incentives:(setting the rules of the game) • Human resource and Facilities - Payment of providers - Paying the facilities, fair pricing • Information system: - The Indicators: Equity, Efficiency, Accountability (Private & Public) • Monitoring, Auditing and feedback - Internal quality Improvement - External friendly evaluation • Incentives and Corrective Actions

  25. Key Research 2: Effective System for Delivery of Optimal Care • Screening, Early TRT, TRT of CKD • DM • Glycemic Control • Eye Exam • Proteinuria • ACEI, ARB • Blood Pressure Control • Dyslipidemia ? • Rehabilitation: CAPD; HD; Transplant

  26. Key Research 3: Unique Risk management • Exposure to and Management of Sore throat • Unique risk of IDDM, NIDDM, MODY • Unique Risk for Hypertension • Renal stones • Use of NSAIDS • HIVAN • Heroine

  27. Key Research 4: Models to Improve Prevention • Creation of Awareness • Lifestyle • Salt Intake • Exercise • Body Weight • Stop Smoking • NSAIDS • Prevent HIV & Heroine

  28. Key Research 5: Clinical Trials & Basic Biomedical Sciences • Involve underprivileged in Clinical Trials of TRT • Specific group with modifiable risk • High Prevalence Areas e.g., stone • Variations in Use & Side Effects of Drugs • Bio-medical research

  29. The Range of Intervention Target High Risk Behavior National Policies Tax Incentives Social Norms Health Promotion Programs Predictive Preventive Medicine Gene Rx Stem Cell Rx Target Society Behavior & Values Biological marker Individual Screening & Rx Community Infrastructure DOWNSTREAM Prevention and Curative Focus UPSTREAM Healthy Public Policy

  30. Success !!! • High Profiles in National & Local Agenda • Good Leaders & Young Researchers • Exchange with Mentoring Networks: "Volunteerism & Virtual Campus" • Information to tract progress. • Periodic Internal Review of Progresses • External Review • Effective Interaction with Political & Social Processes

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