4th Summer Institute (SI-4) - Canadian Coalition for Global Health

4th Annual Summer Institute for New Global Health Researchers
Kerala, India, August 13-21, 2007
SUMMARY REPORT
Hosted by the Centre for Development Studies
in Trivandrum, Kerala, India
It was another remarkable Summer Institute – our fourth. The first three were held in
Halifax (Canada), Ifakara (Tanzania) and Cuernavaca (Mexico). Each one has been special
in its own way, and this fourth Summer Institute (SI-4) was no exception. Our partner
institution this year was the Centre for Development Studies (CDS) in Trivandrum, in the
state of Kerala, in south India, with the local planning team led by Prof. Delampady
Narayana, and health economist at CDS. He served as the co-program chair, along with
Lori Hanson from the University of Saskatchewan. The CDS is research and training
institute with a long history of policy-relevant contributions not only to the state of Kerala,
but to the development of the whole country. [See www.cds.org for more details about the
CDS.]
For many years the state of Kerala state has been known around the world as outstanding
example of “good health at low cost”. Despite the fact that Kerala’s economic profile is
comparable to the India average, the social indicators (education and health) are
significantly better than the national average. Life expectancy for women is 76 years
(compared with about 60 overall in India), and the maternal mortality index is half that of
the India overall (about 200 or less per 100,000 live births, compared to the national rate
of 400). Progressive public policies are a significant part of the explanation about why this
is the case.
More specifically, the link with Prof. Narayana and CDS was greatly facilitated by a longstanding research partnership between the University of Montreal and CDS, with Dr. Slim
Haddad and Prof. Narayana as the principal investigators in a research program entitled:
“Access to Health Care and Basic Minimum Services in Kerala, India” (supported by the
International Development Research Centre – IDRC). This program of research is taking
place in the Wayanad district, in the north-eastern mountainous part of Kerala state. This
research program, now in its second phase, consisted of a detailed household health
survey, including a survey of “colonies” of Indigenous peoples (locally called “hill tribes”).
The second phase focuses on the development and implementation of a Community Based
Health Insurance system, while consolidating existing partnerships with the local
government, a network of women’s self-help groups and local non-governmental
organizations (NGO’s). In other words, the evidence from the Phase 1 survey is now being
used to create a health insurance system and to empower the community—a remarkable
example of “research to action”. This, of course, is the over-arching theme of each Summer
Institute, and explains why the CCGHR approached Prof. Narayana and his team to work
with us on SI-4.
With this context, let’s return to the SI-4 story in more detail.
SI-4 participants and facilitators gather outside the Centre for Development Studies
Selecting Participants
As has been the pattern in previous years, the Coalition’s Task Group on Capacity Building
assembled a planning team to design and manage all aspects of SI-4. A call for applications
appeared on the Coalition’s website (www.ccghr.ca) in January, and was also widely
distributed elsewhere. The objectives, as stated in the “Guidelines and Applications”
document were:
1. To explore the “research to action” challenge—that is, how knowledge can be
translated into policy practice and community action. [Note: this challenge will be
particularly informed by the experience of institutions, individuals and “systems” in
India.]
2. To strengthen participants’ understanding of selected global forces that impact on the
health of citizens in low and middle-income countries (LMICs).
3. Based on an analysis of the role of research in strengthening health systems, provide
opportunities for skill development of relevant competencies such as advocacy,
leadership, partnership building and knowledge translation.
4. To discuss issues related to global health research of particular interest and
importance to those considering a career in this field.
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Applications were received from about 40 “dyads”—that is two persons (one Canadian and
one person from an LMIC) who for the most part were already associated with a specific
project or program. Four 3-person review teams were invited to review the applications,
each team included an SI “alumnus”.
The following individuals graciously volunteered their time to act as reviewers: Carol
Amaratunga, Onil Bhattacharyya, Enrique Cifuentes, Anne Cecile Desfaits, Blye Frank,
Sheila Harms, Lydia Kapiriri, Odette Laplante, Marguerite Massinga Loembe, Alexandra
Martiniuk, Doug McMillan, Alexandra Mihailovic, Thabale Jack Ngulube, Vinh-Kim
Nguyen, Thomas Rathwell, Janet Smylie, Julio Soto, Susan Walker, Sabrina Wong, and
Yilma Yitayew.
Pre-Institute Preparation
The list of successful applicants was posted on the Coalition’s web-site, and soon after this,
all participants were signed up to participate in a specially designated “space” in the
Coalition’s website. Using this space, all participants submitted an individual profile, and
each dyad provided an updated summary of their specific research project. Following the
pattern of previous years, a series of “Pre-Institute Notes” was prepared by the planning
team and posted in the dedicated web-space. Folders were prepared for each presentation
and workshop, and also for the field trips. Each folder included a “resource guide” (which
in some cases contained relevant websites) and key recommended readings. Also included
in the Pre-Institute notes was relevant information about visas, travel arrangements and
preventive health advice.
Knowledge exchange and
discussion with CDS
Professors and students
Participants & Facilitators
As can be seen from the list of dyads and their projects (see below), the discussions at SI-4
were enriched by a remarkable diversity of projects from a wide range of countries. The
countries represented the major regions of the world—Asia, Africa and Latin America (in
addition to Canada). Several of the projects were “multi-country” projects. Despite the
diversity, it was impressive how each project addressed a relevant and important “global
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health” challenge of some kind. Each dyad had a designated facilitator, several of whom
live and work in places other than Canada (see below).
Summer Institute Facilitator-in-Training Programme
An innovation in SI-4 was the “facilitator-in-training” (FIT) program. This involves inviting
previous SI participants to serve as facilitators, with the guidance and supervision of
experienced “senior” facilitators. An announcement was sent to all Summer Institute
“alumni” several months before SI-4, inviting letters of interest in the FIT program. From
seven letters received, two individuals—Lydia Kapiriri (from SI-1) and Oyun Lkhagvasuren
(from SI-3) were selected by the SI-4 planning team. Also very helpful were the
contributions of Subrata Mukherjee and Jean-Frederic Levesque (both SI-3 “graduates”);
they have been very involved in the Wayanad research program and served as resource
persons for several components of the program.
Dyad
Project Summary
Davison – Juma
Strengthening Nurses’ Capacity in HIV Policy
Development in sub-Saharan Africa (Kenya, South
Africa, Uganda) and the Caribbean (Jamaica and
Barbados): exploring the interface between health
system priorities, capacity building and policy
innovations relating to HIV and AIDS.
Reducing the burden of illness due to malaria through a
Community Driven Development (CDD) strategy in the
Democratic Republic of Congo (DRC).
Mercury in rural Ecuadorean and Peruvian households:
social and geographical distribution; and the role of
deforestation, road construction and oil exploitation.
The use of artistic workshops as a healing strategy for
survivors of psychosocial trauma incurred as a result of
political violence during the Chilean dictatorship of
1973-1990.
The role of the Malaysian pharmacy profession in
smoking cessation in Malaysia: adapting training
programs, promoting professional leadership, and
initiating and conducting related research.
Mental Health and Poverty Project (MHAPP): factors in
mental health policy development and implementation,
in four African countries: Ghana, South Africa, Uganda
and Zambia.
Outcomes of HAART among HIV/AIDS patients in Fort
Portal, Uganda: treatment patterns; adherence patterns;
outcomes; and outcome predictors.
Political violence, natural disasters and mental health
outcomes: developing innovative health policies and
interventions: related to the armed conflict between the
Hawkes –
Masumbuko
Webb-Quizpe
Espinoza-Pantoja
BrewsterMohammed
Kakuma – Klentjes
Martin – Kiweewa
Delfin – Robillard
Facilitators & resource
persons
John Frank
Erica DiRuggiero
Enrique Cifuentes
Lori Hanson
Narayana Delampady
Oyunaa Lhkvagasuren
& Subrata Mukherjee
Lydia Kapiriri & Salim
Sohani
Jeff Reading
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Michael - Daley
Shining Path, the Peruvian government and Quechua
communities in the Peruvian highlands.
Improved diagnostic tests for tuberculosis: This team
will conduct a prospective observational study in India,
to evaluate the performance of several newly available
diagnostic tests for tuberculosis (compared to standard
testing).
Manjula Datta & Jean
Frederic Levesque
The Programme
The program was designed to assist and support dyads in their main challenge of the
week—to prepare “research to action” plans for their projects. Early in the week, dyads
summarized their project work to date. The supporting events included carefully selected
and designed inter-active presentations, workshops and field trips. The first two days were
spent in Wayanad district where we met local health officials and health staff, visited a
primary health care centre, and had workshop discussions about the research projects
(described above). As a special “adventure” all participants boarded an over-night train
from Calicut to the capital city of Trivandrum. Other field trips included a visit to a special
health facility specializing in community-based rehabilitative care, and days at the CDS
campus, where we inter-acted with students and faculty. We also took a trip to the Kerala
backwaters—a day that was full of “networking” and informal conversations—in buses and
on a boat. The final day consisted of dyad presentations of “research to action” plans along
with other closing events.
(Presentations, dossiers and learning resources developed and used for SI-4 are currently
available to all at www.ccghr.ca.)
During the closing session, all participants described highlights of their learning,
summarizing these verbally and in writing. They also completed structured evaluations,
providing the planning team with standardized feedback information. In addition,
facilitators provided comments to the planning team about what features worked well and
what components could be improved. Overall, the message from participants was that
their objectives had been achieved and beyond, and that their time together was most
enjoyable and stimulating.
Cultural Performance at the CDS in Trivandrum, Kerala
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SI Alumni Programme
As part of the understanding when participants were accepted for SI-4, dyads will continue
to implement their “research to action” plans over the next 12 months, with help from their
designated facilitators. During a workshop on the Summer Institute Alumni program,
participants made many helpful suggestions about this program. These were discussed
further at an annual meeting of Summer Institute Alumni in conjunction with the Canadian
Conference on International Health in November 2007 in Ottawa.
Thank You to Our Sponsors (Chris, could you put this in a box on the right hand side
also?)
The CCGHR and all of this year’s participants would like to thank the following donors for
their generous support of SI-5:
Canadian International Development Agency (CIDA)
• Conference Secretariat
Canadian Institutes of Health Research (CIHR)
• Ethics Office
• Institute of Aboriginal Peoples' Health, CIHR
• Institute of Infection and Immunity, CIHR
• Institute of Health Services and Policy Research, CIHR
• Institute of Human Development, Child and Youth Health, CIHR
• Institute of Population and Public Health, CIHR
Centre for Development Studies, Kerala, India
International Development Research Centre (IDRC)
• Governance, Equity and Health
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