Transcript Document 7620386

Abstract ID: 481
Author Name: Ebba Holme Hansen
Email: [email protected]
Presenter Name: Kumud K. Kafle
Authors: Hansen EH, Kafle KK, Karkee SB, Onta SR, Subba S, Sthapit S, Kuschel
R, Shrestha AB, Shrestha MP
Institutions: The Danish University of Pharmaceutical Sciences; Copenhagen
University, Denmark; and Tribhuvan University, Nepal
Title: Project on Enhancement of Research Capacity in Nepal:
Interventions on Primary Health Care
Abstract:
Problem Statement: The Nepalese research system partially lacks competence
and capacity in terms of research in primary health care including drug use. There
are also widespread problems in proper functioning of the health care system.
Objective: To strengthen research competence at the university level through
education up to the Doctor of Philosophy (PhD) level, with the goal to improve
health care in Nepal.
Design: Description of PhD graduates’ studies.
Setting and Population: Health care system including primary health care
facilities, and households from two hill districts. Three empirical studies in Jajarkot
district and one study in Kathmandu district including 16 primary health care
outlets, 99 modern health care providers, 10 traditional healers, 24 private drug
sellers, 332 patients, 390 households, 207 married women of reproductive age (1549 years) and 64 key informants.
Outcome Measures: Number of participants exposed to research methodology,
number of local supervisors engaged in the research studies, number of university
departments participating, number of PhD graduates, number of PhD theses
supervised by PhD graduates, number of publications/presentations of research
findings, number and type of issues uncovered.
Results: Two research methodology courses were conducted in Nepal. There have
been four local supervisors from four different departments for the four PhD
graduates. The important findings are: community perception for illness socioculturally constructed, health seeking behaviour of community people based on
cultural world view, social interaction between the community and traditional
provider more dynamic than with modern provider, different dimensions of women
autonomy in household affairs and psychological factors like openness to change
are contributing factors in fertility regulation, immunisation coverage in the district
is exaggerated by over-reporting from primary health care outlets as well as district
office, community knowledge is poor on immunisation, public sector is weak to
manage the drugs including antibacterials, prescription drugs including
antibacterials are available through unofficial sources like private bags and
supervision/monitoring of service outlets very weak. Findings were disseminated
through presentation to the policy makers and health care managers, and
distribution of study reports/articles.
Conclusions: The project has enhanced research capacity, promoted
interdisciplinary research and revealed data on quality of drug systems and health
care as well as community perception on health and service utilisation. The effort is
effective to address the existing gap for the improvement of the health care
system.
Study Funding: DANIDA
Background
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A pilot study on the pharmaceutical
sector in Nepal, carried out in 1991-92,
as well as the preparatory phase of the
present project highlighted massive
problems prevailing in Nepal with regard
to both the activities and organisation of
Primary Health Care (PHC) system and
the scope and quality of research.
Numerous donor organisation activities
in the health sector in general did not
comprise research. Local researcher
training in PHC was not established. This
project aims to bridge the gap.
It was implemented in November 1993
and is on-going.
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Objectives
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To strengthen the research competence of
university students in Nepal, the project
focuses on researcher training up to PhD
level.
To direct the research students' projects
towards PHC in Nepal, so that the results
of the completed research may be
implemented immediately in Nepalese
health policy and in the practice of the
health care system.
To ensure the sustainability of the project,
the project should last for 10 to 15 years
and be implemented in a phased manner
so that the results and experience of one
phase will form the basis of the following
phases. The intention is to establish a PhD
programme in PHC at Tribhuvan University,
Nepal.
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Design
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The project is an integration of two
parallel development scenarios, i.e. a
research training programme and an
interdisciplinary research programme,
topic of which is Primary Health Care.
Training Programme
The training programme has three
components
 course on research methodology in
PHC in Nepal,
 training of PhD students,
 establishment of a PhD programme
in PHC in Nepal, including specialised
research courses.
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PhD Programme
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A sandwich programme, the students are
trained in Denmark as well as Nepal.
Fieldwork and data collection entirely in
Nepal. Theoretical courses in different
institutions of Denmark. Data analysis,
article and report writing in Denmark and
Nepal.
The Departments included –
Nepal: Community Medicine and Family
Health, Clinical Pharmacology, Sociology
and Anthropology and Psychology, TU
Denmark: Social Pharmacy (The Danish
University of Pharmaceutical Sciences),
Psychological Laboratory (CU),
Epidemiology and Social Medicine
(University of Aarhus), Department of
Epidemiology (CU) and Danish Institute for
Health Services Research and
Development.
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Training on Research
Methodology and selection
of PhD students
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The first course was organised in
1994 and the second in 1997.
Selection of participants for the
training course included
advertisement in national newspaper,
radio and selection from the
applicants based on qualifications and
experiences.
The selection of PhD students was
primarily based on their performance
during the course. The selection of
students for PhD programme was
multidisciplinary (health sciences,
social sciences and the humanities).
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Results
Number of participants in
Research Course
Year
1994
1997
Number
15
16
PhD students enrolled
Discipline
Number
Social Pharmacy
2
Epidemiology and
Public Health
2
Social Psychology
2
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Research Projects
Title
Remarks
1. Health Information System in Nepal
Completed
2. Issues in Antibacterial Provision in Primary
Health Care in Nepal
Completed
3. Perception of Disease and Illness Among
Health Providers and Health Seekers in Jajarkot
District, Nepal
4. Women's Autonomy and Fertility Regulation
Among Rural Women of Kathmandu District,
Nepal
Completed
5. Home and Hospital Deliveries in Relation to
their Determinants and Determinants &
Outcomes of Delays to Maternity Care.
On-going
6. Perception, Beliefs and Attitudes Related to
Tuberculosis and to Explore the Factors
Underlying Treatment Behaviour.
On-going
Completed
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Population Covered by
Completed PhD Projects
Traditional Healers
10
Private Drug Sellers
24
Patients
332
Households
390
Married Women of Reproductive Age
(15-49 years)
207
Key Informants.
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Issues Uncovered by the
Completed Projects
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Community perception for illness socio-culturally
constructed,
Health seeking behaviour of community people
based on cultural world view,
Social interaction between the community and
traditional health providers more dynamic than with
modern providers,
Different dimensions of women’s autonomy in
household affairs and psychological factors like
openness to change are contributing factors in
fertility regulation,
Immunisation coverage in the district is exaggerated
by over-reporting from PHC outlets as well as
district office,
Health related data reported from health facilities
less reliable
Community knowledge on immunisation is poor
Public sector weak to manage the drugs including
antibacterials,
Prescription drugs including antibacterials available
through unofficial sources like private bags
Supervision/monitoring of service outlets very weak.
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Dissemination of Research
Results
Publication of article
7
Article under publication
10
Conference/seminar presentation
(international)
4
Policymaker/Planner
3
Incorporation into curricula:
undergraduate medical & public health,
and postgraduate psychology
Outputs following the Capacity
Enhancement of PhD Graduates
Post-graduation Thesis Supervision
7
PhD Thesis Supervision
2
Other Research Activities
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Authority development (policy advocacy
and promotion): promoted to higher
and responsible positions
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Conclusion
The project has enhanced research
capacity, and revealed data on
quality of health care as well as
community perception on health
and service utilisation.
The effort is effective to address the
existing gap for the improvement
of the health care system in Nepal.
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