Western Cape: Research strategy and way forward. Tony Hawkridge Director: Health Impact Assessment Western Cape Government: Health

Transcription

1 Western Cape: Research strategy and way forward Tony Hawkridge Director: Health Impact Assessment Western Cape Government: Health

2 Context

3 AFRICA HEALTH STRATEGY: Health Research provides the evidence for policy- and decision-makers at all levels to make efficient and effective decisions The content of research is critical and needs to go beyond determining prevalence to explore what social and psychological factors are behind health choices, and what factors lead to success of interventions.

4 AFRICA HEALTH STRATEGY: The African continent must have locally driven and financed research which generates information to inform policy and plans. Empowerment of local researchers and resource allocation for research are critical factors for development of innovative approaches and interventions, which are sensitive to the peculiarities of Africa. Research in general, and operational health systems research specifically, is a necessity for improving health system performance. In consequence, countries should build research capacity and allocate at least 2% of national health expenditure and 5% of project and programme aid for research. They should prepare legislation governing research and establish or strengthen national health research systems and establish platforms for research to be presented so that it can indeed influence health policy and practice.

5 South Africa Legislative and other mandates National Health Act (2003) Objects of the NHA are to establish a health system based on internationally recognised standards of research STRATEGIC PLAN 2014/ /19

6 South Africa STRATEGIC PLAN 2014/ /19 Research Summit convened in 2011: 7 themes as the main priority for action : 1. Funding 2. Human Resources 3. Health Research Infrastructure 4. Priority Research Fields 5. National Regulatory Framework 6. Planning and Translation 7. Monitoring and Evaluation Establishment of a Research Observatory for SA Department will continue to audit Research Ethics Committees to ensure research is ethical and support good governance of REC s.

7 South Africa STRATEGIC PLAN 2014/ /19 2 statutory bodies which create a conducive environment for health research in SA (as mandated in the National Health Act, 2003): National Health Research Committee National Health Research Ethics Council 2 institutions which drive the research agenda Medical Research Council Health Systems Trust

8 South Africa STRATEGIC PLAN 2014/ /19 NDOH Program 2 Strategic Objectives relating to Health Research Strategic Objective: Ensure research contributes to the improvement of health outcomes Objective Statement: Establish a National Health Research Observatory Indicator Functional National Health Research Observatory Baseline 2013/14 Draft concept paper and HST report on best practice Target 2018/19 Observatory established by 2018/19.

9 South Africa STRATEGIC PLAN 2014/ /19 NDOH Program 6 Strategic Objectives relating to Health Research Strategic Objective: Provide for coordinated disease and injury surveillance and research Objective Statement: Establish National Public Health Institute of South Africa (NAPHISA) Indicator NAPHISA established Baseline 2013/14 Draft concept for NAPHISA Target 2018/ : NAPHISA Business Case and Conceptual Framework 2019: NAPHISA established

10 South Africa - Public Entities involved in Health Research STRATEGIC PLAN 2014/ /19 Medical Research Council Established 1969 Relevant Acts: SA MRC Act 1991 Intellectual Property Rights from Publicly Financed Research and Development Act (2008) Strategic Focus determined by priorities of DOH and government especially key outcome #2: a long and healthy life for all South Africans. Outputs: Administer health research effectively and efficiently in SA Lead generation of new knowledge and facilitate its translation into policies and practices to improve health Support innovation and technology development to improve health Build capacity for the long term sustainability of the country s health research Budget in 2014_15: R818m.

11 SA NDOH APP 2014_ _17

12 SA NDOH APP 2014_ _17 pg 40 Program 2 PROGRAMME 2: NATIONAL HEALTH INSURANCE, HEALTH PLANNING AND SYSTEMS ENABLEMENT 2.1 PROGRAMME PURPOSE Improve access to quality health services through the development and implementation of policies to achieve universal coverage, health financing reform, integrated health systems planning, reporting, monitoring and evaluation and research. Sub-programmes: Health Information Management, Monitoring and Evaluation In 2012/13,a concerted effort was made to strengthen research and development. The department commenced with the implementation of recommendations from the National Health Research Summit by funding 13 PhD scholarships and an independent audit of 33 research ethics committees was commissioned on behalf of the National Health Research Ethics Council. This sub-programme has 48 filled posts.

13 Western Cape - HealthCare 2030

14 Western Cape - HealthCare 2030 Monitoring and Evaluation pg xxii Health research is critical to understanding the well-being of the population, the burden of disease, its associated risk factors and populations at highest risk as well as the performance of the health system with regards to access, quality, efficiency and impact. which rephrased could read:

15 Western Cape - HealthCare 2030 Monitoring and Evaluation pg xxii without health research it is impossible to understand how healthy or unhealthy a population is, what diseases affect it, what is causing those diseases, which subpopulations are worst affected, or how well a health system is performing in terms of delivering accessible, high quality, efficient and high-impact health care. which is quite a radical thing to say

16 Western Cape - HealthCare 2030 The Role of Research A robust and rounded understanding of the health system requires an inter-disciplinary approach that includes, amongst others, clinical disciplines, public health, health economics, management and social sciences to allow the evaluation of a wide range of interventions from clinical health services to organisational culture change, leadership development, collaboration with the private sector. Similarly, the approach of Healthcare 2030 of increasing wellness necessitates an understanding of social determinants and with that also requires an inter disciplinary approach to research that includes social sciences as well as participatory methodologies that include the communities which we serve.

17 Western Cape - HealthCare 2030 The Role of Research Interdisciplinary approach Wide range of interventions Clinical Evaluation Clinical health services Social sciences Public Health Organisational culture change Management sciences Health economics Collaboration with the private sector Leadership development

18 Western Cape - HealthCare 2030 The Role of Research The following would be key strategies to improve research in the department: 1. Building a culture of using research to improve services; 2. Development and dissemination of a research agenda; 3. Capacity development of staff on the utility of research and conducting research especially operational research; 4. Structured processes to collaborate with researchers (including researchers & specialists in training) on strategic research questions such as trials to evaluate the effectiveness of complex interventions aimed at behaviour change; and 5. Dissemination and translation of research findings into policy and practice to positively impact on service delivery and health outcomes. 6. The Department will engage and partner with the HEIs and other associated agencies to access their expertise to effectively undertake the above challenges. 7. The Department will enhance its public health intelligence by being constantly aware of the public health research and data put out by HEIs and allied organisations. This will help to build and monitor the rich picture of public health in the province that needs to be addressed.

19 Western Cape - HealthCare 2030 Building a culture of using research to improve services There is compelling evidence that the strength of the primary care system in a region or country predicts the health status of the population. There is a growing awareness that research in primary care is needed for a strong primary care system to provide excellent clinical (and population-based) care, to develop effective health systems and policies, and to educate future primary care professionals and researchers. Beasley JW et al, J Am Board Fam Med Nov-Dec 2007 vol. 20 no

20 Western Cape - HealthCare 2030 Development and dissemination of a research agenda Development Who sets the agenda? Nationally, provincially, locally? What are the criteria? What is the Department s role in influencing it? Is it enforcable? OR Health needs Health needs Dissemination How do we best communicate with stakeholders regarding our needs and priorities? Health research Health research

21 Western Cape - HealthCare 2030 Capacity development of staff on the utility of research and conducting research, especially operational research Which staff need to be encouraged to develop their capacity? Who should do the developing? Formal, academic or informal, in-service? Who pays? Importance of role models Importance of success stories Examples of visible differences made

22 Western Cape - HealthCare 2030 Structured processes to collaborate with researchers on strategic research questions Research partnerships what does partnership mean in this context? What does collaboration mean? Roles and responsibilities? Local, intra-provincial, inter-provincial, international How do we remain equal partners? How do we share the work, the learnings, the gains, in our context?

23 Western Cape - HealthCare 2030 Dissemination and translation of research findings into policy and practice to positively impact on service delivery and health outcomes Getting Research Into Practice (GRIP). How do we ensure that the published paper is not the end of the story? Is a feedback session with district / facility management enough? Where does one s moral duty as a researcher end? Handover? What is the community s role?

24 Western Cape - HealthCare 2030 The Department will engage and partner with the HEIs and other agencies to access their expertise to effectively undertake the above challenges How accessible is the expertise of HEI s and other agencies? What are the rules of engagement? What sort of expertise is the department lacking which the HEI s/agencies can provide Who decides which challenges to undertake? How can we craft partnerships which maximally benefit both parties, and also our communities?

25 Western Cape - HealthCare 2030 enhance its public health intelligence by being constantly aware of the public health research and data put out by HEIs and allied organisations. This will help to build and monitor the rich picture of public health in the province that needs to be addressed How does a Departmental employee keep up with the research and data output of the partners? How can the partners make this more attainable? How essential is it that the Department is aware of all research taking place in the province? Is it even possible? If not, where should the focus be? How important is it for researchers to communicate their results to the Department? How best can this be done?

26 A few words about our Research sub-direcotrate Dr Sabela Petros (DD) Dr Virginia Zweigenthal (PHS) Ms Charlene Roderick (ASD)

27 Western Cape Health Department: Health Research Health Department HEI s MRC CD: Strategic Support D: Health Impact Assessment SD: Health Research HST NGO s Facilities Pharma Foundations / PDP s Districts

28 Research Sub-directorate Tracking / able to report on e.g.: Amount of health research being conducted in the WCape Where this is done Who is conducting the research Research conducted in rural areas/districts, Which rural districts get the bulk of the research Provincial Health Research Committee: guides and advises government on health research matters.

29 Research Sub-directorate Goal: to promote evidence-based health service delivery through supporting the conduct of research, ensuring the utilization of research findings for improved practice and policy and promoting a culture of research uptake within the health services in the Western Cape. by doing the following 1. Provincial Research Priorities setting 2. Application processing and approval 3. Promoting discussion and utilization of research evidence for decision making. (Policy briefs; research newsletters, research days and research reports) 4. Managing and co-ordinating limited health research resources for best effect and greatest impact 5. Promoting the translation of relevant research into policy/policy briefs and practice through; 6. Strengthening the research culture within the Department - capacity building, priority setting; 7. Using research for evidence based decision making; 8. Dissemination of research findings through facilitation of research report/feedback to institutions where research was conducted. (via Districts & Sub-structure research days).

30 Research Sub-directorate Challenges: 1. Fund raising and commissioning of research; 2. Research reports feedback from researchers; 3. Building and implementing the culture of health research within the Department; 4. Focusing of research in neglected areas (research gaps).

31 Western Cape - HealthCare 2030 Research is necessary to better understand the complex health service and improve clinical care. Interventions need to be evaluated so that lessons can be learned. Best practices will be shared

32 Thank you

33 Western Cape - HealthCare 2030

34 Elements: Goal 1: Establish the NHS as an internationally recognised centre of research excellence Goal 2: Attract, develop and retain the best research professionals to conduct peoplebased research Goal 3: Commission research focused on improving health and social care Goal 4: Manage our knowledge resources Goal 5: Act as sound custodians of public money for public good UK

35 Scotland 5 areas critical to future success: Efficient R&D Support for Research Partnership with Patients and the Public Targeted Deployment of Resources Working in Collaboration Investing in the Future

36 SA NDOH APP 2014_ _17 pg SA MRC 3. South African Medical Research Council Established in 1969 in terms of the South African Medical Research Council Acts (1969 and 1991). The Council is required to promote the improvement of health and quality of life through research development and technology transfer. Research and innovation are primarily conducted through councilfunded research units located within the council and in higher education institutions. The council s strategic focus is determined in the context of the priorities of the Department of Health and government. The council s research therefore plays a key role in responding to government s key health outcome: a long and healthy life for all South Africans.

37 SA NDOH APP 2014_ _17 pg 58 Program 3 PROGRAMME 3: HIV / AIDS, TB AND MATERNAL AND CHILD HEALTH 3.1 PROGRAMME PURPOSE The overall purpose of programme 3 is to decrease the burden of disease related to the HIV and TB epidemics; to minimise maternal and child mortality and morbidity; and to optimise good health for children, adolescents and women. This is done through the three overarching strategies of 1. setting policies, guidelines, norms, standards and targets; 2. supporting the implementation of these; and 3. monitoring and evaluating the outcomes and impact of this implementation. The management of the programme have to ensure that all efforts by all stakeholders are harnessed to support the overall purpose. This includes ensuring that the efforts and resources of Development Partners, funders, academic and research organisations, non-governmental and civil society organisations and civil society at large all contribute in a coherent, integrated fashion.