Producing and transferring local knowledge

Global symposium on health system research (Beijing, 31 oct. – 3 nov. 2012)

Emilie Robert Dembélé Youssouf

Outline

1.  Context

2.  What research knowledge (RK) was transferred?

3.  To whom was the RK transferred?

4.  By whom was the RK transferred?

5.  How was the RK transferred?

6.  With what effect was the RK transferred?

© Robert & Dembélé, 2012

Context Several free care policies:

•  Free care for under 5 (NGO)

•  Distribution of free mosquito bednets (gvt+NGO)

•  Free malaria treatment (gvt)

•  Caesarian (gvt)

•  HIV treatment (gvt)

MALI

Objectives: To use existing data from the information system and to produce new knowledge to fuel decisions on user fee exemption policies.

© Robert & Dembélé, 2012

1. What RK was transferred? (1)

Dimensions RK produced by the Ministry of health

RK produced by University of Montréal

Utilization of health services

-  Curative consultation coverage in Kangaba -  Access to C-section in Bamako. -  Effects of free ACT on accessibility of children living further than 5 km from a community health centre (CsCom) -  Effects of free mosquito bednets on prenatal care in Sikasso

-  Effects of free care of curative care for children under 5 on consultation in Kangaba

Financial aspects / costs of UF exemption policies

-  Effects of free anti malaria on financial capacity of community health centres (CSCom) in Bamako -  Effects of free care on financial capacity of community health management (ASACO) in Kangaba

-  Costs of curative consultation for children under 5 (scaling up)

Actors’ perceptions of free care

-  Perception of health staff on free anti malaria in Sikasso and Kayes -  Perception of users on free anti malaria in Sikasso -  Opinion of Kangaba population on cessation of free care for children under 5

© Robert & Dembélé, 2012

2. To whom was the RK transferred?

Internal level •  Participants in Observatory (HIS officers, district medical

chieves, regional planning officers, national HMIS managers)

External level •  Ministry of health (national director, planning and statistics

chief, general secretate) + non participant regions •  NGOs (MDM, MSF, ACF, HKI) and national civil society

(Fédération nationale des ASACO) •  Donors (ECHO, EC, World Bank, WHO, UNICEF) •  Bilateral agencies (France, Canada, Netherlands, USA)

© Robert & Dembélé, 2012

3. By whom was the RK transferred?

•  Supervision team – University of Montreal, researchers with technical

expertise

– Médecins Sans Frontières – Belgium: coordination of the strategy and fundraising

–  National Directorate of the Ministy of Health: operational side of the research, access to the health system information

© Robert & Dembélé, 2012

4. How was the RK transferred?

•  Modelization of the knowledge translation strategy theory (post-intervention)

•  Objective:

→ To evaluate the potential for achievement of the KT strategy

•  Sources:

–  Interviews

–  project documents

–  KT literature © Robert & Dembélé, 2012

Building of the teams’ technical capacities

Utilization of HIS data

The legitimacy of the Obs. is established.

Better utilization of knowledge in decision-making on user fee exemption measures

The credibility of knowlege is ensured.

Process utilization

National dissemination workshop

Conduct of studies by the Observatory teams

Adaptation and dissemination of

knowledge

Support to the Observatory to produce

knowledge

Involvement of local stakeholders in

producing knowledge

Knowledge is accessible.

Supervision of the production of knowledge

Administrative and financial support during 12 months; UdeM / MoH / MSF-B / ECHO partnership ; human resources; equipments; consumables; infrastructures

EXPE

CTE

D

RES

ULT

S O

BJE

CTI

VE

Prioritizing needs for knowledge with

Observatory teams

PRO

CES

S

Implication of target users in identifying needs for

knowledge

Preparation of protocoles by the Observatory teams

Knowledge is useful to target users.

INPU

TS

Presentations at local meetings

© Robert, 2011

AC

TIVI

TIES

Participative process

Publication of policy briefs on new knowledge

Conduct of independant studies by UdeM

At the local level

At the national level

At the internat.

level

Workshop for the identification of needs for

knowledge

5. With what effect was the RK transferred?

Expected results

Facilitators Obstacles Potential for achievement

1) Knowledge is useful to target users.

KT strategy: •  Involvement of potential users in the identification of needs Context: •  Answer to an explicitly formulated need •  MDGs context

KT strategy: •  Poor targeting of decision and policy makers ++

2) The legitimacy of the Observatory is established.

KT strategy: •  Endogeneous process of knowledge production •  Technical support from partners Context: •  Local initiative and institutional anchoring

+++

© Robert & Dembélé, 2012

5. With what effect was the RK transferred?

Expected results

Facilitators Obstacles Potential for achievement

3) The credibility of knowledge is ensured.

KT strategy: •  Scientific support from partners Context: •  Long-term collaboration between partners

KT strategy: •  Validity of data produced by the Observatory •  Short-term trainings and one-year strategy

+

4) Knowledge is disseminated and accessible.

KT strategy: •  Workshop and policy briefs Context: •  Strong involvement of key stakeholder (messenger)

KT strategy: •  Push strategy •  No dissemination plan •  Participants with low leverage

-

5) Process utilization

KT strategy: •  Better understanding of the ins and outs of free healthcare at the local level •  Trainings Context: •  Mid-term sustainability

KT strategy: •  No national potential users involved in the process •  Life span of the KT strategy

+

© Robert & Dembélé, 2012

Youssouf Dembélé is the Executive Director of the Alliance Médicale Contre le Paludisme au Mali.

Emilie Robert is a Ph.D. student in public health at Montreal University (Canada). She is working under the supervision of Dr. Valéry Ridde. She is a senior fellow of the Global Health Research Strengthening Program (GHR-CAP), funded by the Canadian Institutes of Health Research and the Population Health Research Network of Quebec. She holds a scholarship from the Quebec Fund for Nature and Technology Research. She has a travel grant from the Research centre of University of Montreal hospital centre (CRCHUM).

Contacts: youssoufaly@yahoo.fr / emilie.robert.3@umontreal.ca

Acknowledgments to the team: •  Dr. Valéry Ridde, Montreal University •  Dr. Slim Haddad, Montreal University