2013
Internship Report Research Promotion and Development Health Systems and Services, HSS/HR
Jimmy Toan Lê July – December 2013
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Contents I. Introduction ............................................................................................................................................... 5 II. Background .............................................................................................................................................. 6 III. Terms of Reference ............................................................................................................................... 10 IV. Duties and Responsibilities (Internship Activities) .............................................................................. 11 A. Preparatory review of Research for Health (CD 49/10) and (brief) analysis of national health research systems in the Americas ........................................................................................................... 11 B. Advancing the Draft of a Strategy and Plan of Action to advance the Policy on Research for Health ................................................................................................................................................................ 12 C. Implementing and analyzing a survey for the implementation of PAHO’s Policy on Research for Health (CD49/10) in the PASB and Member States, providing a summary and instructions from future surveys .................................................................................................................................................... 13 D. Assembling the research poster on ―Online capacity building in translating research into practice for Latin American researchers‖ and workshop presentations ..................................................................... 15 E. Research Interest Group (Two) .......................................................................................................... 16 F. Art for Research.................................................................................................................................. 17 G. Malaria Day in the Americas Report ................................................................................................. 18 H. (Ongoing) Research Paper on ―Decision makers, scientific evidence and health policy decision making‖ ................................................................................................................................................... 18 I. (Ongoing) Case Study – Revisit of Kangaroo Mother Care ................................................................ 19 J. (Ongoing) Networking and Visits ....................................................................................................... 19 V. Discussion (Assessment of the Internship) ............................................................................................ 21 VI. Recommendations................................................................................................................................. 23 VII. Conclusion ........................................................................................................................................... 24 Works Cited ................................................................................................................................................. 25
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Main Messages
The internship in Health Systems and Services, Health Resources for Health, Bioethics, and Research at PAHO was an opportunity to contribute to ongoing initiatives in advancing the promotion and development of research for health through analyzing descriptors of national health research systems and studying the trends of national health policies.
PAHO’s Policy on Research for Health (CD 49/10) represents the flagship regional policy on health research and outlines how health systems and services in the region can be strengthened through research. Consequently, implementation of this policy by both Member States and the Secretariat must be evaluated and assessed.
The returns of research are not always evident. Research is one mean of highlighting community benefits and circumventing health challenges. During the internship entails the use of a variety of tools and resources to communicate this message, from social media to art galleries to evaluations and case studies.
Networking is a critical skill. PAHO is an environment that promotes excellence and high visibility which in turn recruits experts, specialists, politicians, and decision makers from various sectors and disciplines. Likewise, interns come from a diverse background with much experience to share. Furthermore, the internship program exposes interns to various external agencies through visits to organizations and institutions such as the IMF, World Bank, IADB and OAS.
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Executive Summary The Pan American Health Organization through Research Promotion and Development seeks to advance the role of research for health at various levels. This task requires involvement from a variety of disciplines and sectors. Further, since the returns of research are not always evident, it is critical to employ a wide assortment of tools including case studies and evaluation frameworks, but also art, social media, interest groups, and networking. The internship at PAHO was therefore an opportunity for real-world experience in public health governance and application of materials covered in the classroom into practice. PAHO sustains an international work environment that promotes research excellence and high research visibility. During this period, I also met researchers and policymakers coming from across the world. Attending important events at PAHO such as the 52nd Directing Council in
October gave me a preview of policymaking from start to finish. Likewise, workshops and webinars on issues like neglected diseases, safe travel, and malaria reminded me of the important role that this organization plays. While I intend to pursue a career in academia or research, I want to produce evidence that guides decision making.
Seeing ambassadors, country
representatives, and even a former president in the rotunda assures me that—idealistic as it sounds— there is still indeed an audience waiting to read my work. As a graduate student studying international affairs and global health, I am interested in looking at public health from the policy side where global refers to not just geographical context but also in terms of topic and scope of the problem. This internship met this interest in addition to exposing me to new ideas and new interests.
It familiarized me with the mission and
objectives of PAHO and provided me with invaluable input from various perspectives and specializations. For example, the MDGs outlined in 2000 serves as testament to the systematic, inter-connected nature of health to development. By calling in researchers from other fields together, including Dr. Francisco Cumsille, head of the Inter-American Observatory on Drugs from the Organization of American States (OAS) or Dr. Cristina Rabadan-Diehl Deputy Director of the Office of Global Health (OGH) from the NIH, I explored public health from political and
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scientific angles. Likewise, with the Art for Research galleries at PAHO, my supervisor and I juggled the idea of using other media to flesh out the returns of research. In case of an exposition like ―Transformation for Development,‖ research—visually—becomes a driver of social and economic growth that tackles the socioeconomically determinants of health. While six months was only a short period, I have no doubt that my experience working at PAHO has set a firm foundation upon which I would like to build in the near future. My previous educational training has provided me with the fundamental knowledge and a general idea of how I want to look at health services and health interventions that improves human wellbeing, by the time I invested at PAHO opens up a toolbox, introducing new angles to look at global health challenges in addition to new mentors and potential colleagues whom I intend to keep in close contact. As agreed with the supervisor and stated within the Terms of Reference issued on May 10, 2013, the primary objectives of this internship were to (1) contribute to ongoing initiatives to advance the development of a Plan of Action or Strategy on Research for Health for the Region of the Americas, (2) analyze descriptors of national health research systems in addition to (3) studying trends of certain research studies and topics. Between July and December 2013, I executed these activities to the best of my abilities and, to my knowledge, have successfully advanced or completed all three objectives. The extent of my participation and an assessment of my involvement are documented in the following sections of this report.
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The Report I. Introduction The Russian author Tolstoy cautions, in his first true novel, that "happy families are all alike." Rather, it is the unhappy ones that are each unhappy in their own way. I allude to this Anna Karenina principle, to call out failing health research systems which, like unhappy families, are each unique in their own ways. My work at PAHO these past six months was to come up with a way to isolate these anomalies and push for better practice through an international work environment that promotes research excellence and high research visibility. The ―institutional arrangements‖ from WHA 43.19 led to creation of working divisions like Research Promotion and Development under Health Systems and Services at the Pan American Health Organization (PAHO). Undoubtedly, the firsthand experience mediated through the internship in a knowledge-based organization like this Regional Office, and by extension, the World Health Organization itself, gives me a preview of how international organizations operate and how they answer to international mandates and calls to action. While six months was only a short period, I have no doubt that my experience working at PAHO has set a firm foundation upon which I would like to build in the near future.
My previous
educational training has provided me with the fundamental knowledge and a general idea of how I want to look at health services and health interventions that improves human well-being, by the time I invested at PAHO opens up a toolbox, introducing new angles to look at global health challenges in addition to new mentors and potential colleagues whom I intend to keep in close contact. Therefore, the purpose of this report is to explain what I did and learned during my sixmonth internship at the Pan American Health Organization, during between July and December 2013 at the PAHO Headquarter (WDC) office in Washington, D.C. This internship satisfies the practicum period (stage obligatoire) during the third semester of my graduate program at the Paris School of International Affairs of Sciences Po, Paris (Institut d'études politiques de Paris). Although the Report represents a concise summary of projects advanced, completed, or in-
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progress, it can also be used as a transition tool for future participants of the Research Promotion and Development internship.
II. Background At the Forty-Third World Health Assembly (WHA) in March 1993, health research took a stand on the international arena for the first time. Through resolution WHA 43.19, the World Health Organization (WHO) called all Member States to undertake essential health research and appropriate them to national needs. This resolution cited research as a means of identifying health priorities and improving health policy and management while contributing to new knowledge, foster innovation and address limits in resources. [1] To that end, the WHO further encouraged world leaders to engage bilateral and multilateral agencies in order to build and strengthen national capacity by investing in and creating environments that will foster scholarship and creativity. The same resolution requested the Director-General to develop more effective ―institutional arrangements‖ for strengthening research capabilities with emphasis on disciplines of critical relevance to public health, including medicine and communications. Between then and now, in 2013—two decades following the passing of this Resolution— research has taken an remarkably higher profile than ever to first meet and then go above and beyond items outlined in WHA 43.13. This follows a trend in dramatic increase of funding for global health, a stronger interest in innovation and technology, an emergence of numerous global health research initiatives, a raise in awareness of health systems research, and a shift to evidence-informed policymaking and practice. [2] The longing for research further manifests undoubtedly through appeals and mandates that stems not only from the WHO and its Regional Offices like PAHO but other entities within the United Nations (UN) system, national and subnational governments, science and technology, academia, and inter-government and development agencies. For instance, while the General Assembly of United Nations adopted the Millennium Declaration and the subsequent Millennium Development Goals (MDGs) in 2000 [3] as a means of defining basic standard of living, it also committed world leaders to. poverty (MDG1), hunger (MDG1), illiteracy (MDG2), disease (MDG6), environmental degradation (MDG7), and violence and discrimination against women (MDG3). This extensive list represents many
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socioeconomic determinants of health as well as barriers to health access. In order to appraise achievement in eliminating these challenges, governments at all levels must conduct research to gauge progress, revisit action plans, and revise them as needed. Hence, the General Assembly developed measurable indicators in conjunction to the goals as outlined in the Declaration. At the Ministerial Summit on Health Research in Mexico in 2004, the WHO fleshed out the role of research as a vital instrument in the improvement and sustainable development of population health. In addition to its role as a monitoring and evaluation mechanism based on defined indicators, there was special emphasis on translating into action and narrowing the ―know-do gap.‖ [4] Oftentimes today, a chasm exists between scientific advancements and their application, where there are marked differences between ―what we know and what we do in practice.‖ In this context, the we refers to anyone from a farmer in Asia, a doctor in Africa, a health educator in the Americas, biomedical companies, religious orders, politicians, legislators, judicators, etc. [5] According to the Summit, the main approach to bridging the gap manifests through pushing information out to as many people as possible and making sure that this information is both comprehensive and comprehendible. Yet the significance of research comes into the picture once more through the Bamako Call to Action in 2008. [6] A major setback, according to this Ministerial Forum, lies with the lack of resource both human and financial. Characterized as the ―10/90 gap,‖ a disproportionate amount of research expenditure is allocated to health challenges that target the marginalized, poor, and disadvantage communities. The Call to Action urged governments to allocate at least 2% of health budgets to research, including support to knowledge translation. Bringing representatives from multiple sectors, including agriculture, also demonstrated the importance of intersectorality where the discussion is no longer just about health research but rather ―research for health.‖ This change highlights the importance of multisectoral, multidisciplinary participation where health research can emanate from any field, be it economics, road safety or even agriculture. Additionally, the higher profile research for health takes on now also resulted from creation of agencies and programs that regulate health research, for example the Council on
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Health Research for Development (COHRED)1, the World Health Organization International Clinical Trials Registry Platform (ICTRP) 2 and the Evidence Informed Policy Network (EVIPNet).3 Collectively, these directives work to ensure that a complete view of research is accessible to health care decision makers, which in turn leads to better transparency and ultimately, human development. For the Americas, WHO activity and initiatives come into existence through actions of the Pan American Health Organization. In 2009, the Organization passed a Policy on Research for Health, which is an overarching policy that underpins all of PAHO’s work. [8] It is a means of integrating research into other policies, strategies and of action carried out by PAHO, facilitates the creation and enhancement of robust NHRS and assigns the Research Promotion and Development team within PAHO as the entity responsible for its evaluation. Thus, within PAHO, the Research Promotion and Development team through Human Resources for Health, Bioethics and Research (HR) division within Health Systems and Services (HR) department under the office of the Assistant Director—Dr. Francisco Bercerra-Posada, MD, MPH, DrPH— represents steps taken by this Regional Office for the Americas to strengthening research capacity in the area of health policy under the following tenets: [7] Vision: A world of healthy people through the promotion and facilitation of scientific, evidence-informed and equitable policy-making and practices. Mission: To catalyze sustainable improvements that rest on policies and practices informed by research evidence for the Americas. This team is lead by Senior Regional Research Advisors Dr. Luis Gabriel Cuervo, MD, MSc and Lic. Eleana Villanueva in conjunction with Dr. Evelina Chapman, MD and Dr. Ludovic Reveiz, MD, MSc, PhD to follow two main lines of action: 1. Strengthening national health research systems (NHRS) 2. Coordinating research governance within the Pan American Health Organization
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COHRED: http://www.cohred.org/ ICTRP: http://www.who.int/ictrp/en/ 3 EVIPNet: http://global.evipnet.org/ 2
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In short, Research Promotion and Development provides technical cooperation to implement guidelines and recommendations including PAHO’s Policy on Research for Health with the aim of improving population health by strengthening health systems, promoting knowledge translation and good governance of research for health. Bearing in mind that PAHO as a decentralized organization comprises of two branches, the Secretariat (i.e. the Pan American Sanitary Bureau) and the Member States themselves, through its workings Research Promotion and Development collaborate with both sides in order to contribute to PAHO’s objective attaining equitable health and development for people in the Americas.
For this reason, in accordance to the aforementioned mandates, resolutions, calls to actions, agencies, policies, collaborations and requests that have come forth from the international, regional, national and sub-national communities over these past three decades in the Region, the Internship in Research Promotion and Development expands on various ongoing initiatives. Projects partaken in by interns highlight the importance of human well-being and development as well as implementation of PAHO’s Policy on Research for Health. Under the direct supervision of Dr. Luis Gabriel Cuervo and Eleana Villanueva, an assortment of systematic, inter-related activities were successfully accomplish to either pave way for or advance the Organization’s understanding of research governance and strategize steps to take next through the internship placement in Research Promotion and Development.
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III. Terms of Reference As agreed with the supervisor and stated within the Terms of Reference issued on May 10, 2013, the primary objectives of this internship were to (1) contribute to ongoing initiatives to advance the development of a Plan of Action or Strategy on Research for Health for the Region of the Americas, (2) analyze descriptors of national health research systems in addition to (3) studying trends of certain research studies and topics. These objectives manifest through the following five expected products: 4 (1)
An advanced draft of a strategy and plan to advance the Policy on Research for Health
(2)
Implementing and analyzing a survey for the implementation of PAHO’s Policy on Research for Health (CD49/10) in the PASB and Member States, providing a summary and instructions from future surveys.
(3)
An analysis of national health research systems in the Americas
(4)
Participates in activities organized for interns and by interns including the Research Interest Group (conducting Brown Bag lunches and a study case) among others.
(5)
Contributions to publications as agreed with his supervisors.
The Research Promotion and Development team has an assortment of ongoing initiatives with key internal and external partners. Following mandates and advice from PAHO’s Advisory Committee on Health Research, research advisors are developing a Plan of Action for PAHO’s Policy on Research for Health which includes a report card to monitor the implementation of this policy by both the Secretariat and Member States. Under the mentorship and supervision of Dr. Cuervo and Mrs. Villanueva, interns regularly interact with other team members as needed to keep one another abreast of critical issues and development. To date, all three activities were attempted and accomplished to the maximum extent, bearing in mind that the methodology for NHRS descriptors/evaluation and strategic plan must now undergo review by the Advisory Committee on Health. This 1-3-25 Report thus serves as testimony to activities undertaken by me. 4
Extracted from the Terms of Reference prepared for Jimmy Toan Le on May 10, 2013
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IV. Duties and Responsibilities (Internship Activities) A. Preparatory review of Research for Health (CD 49/10) and (brief) analysis of national health research systems in the Americas Prior to carrying out the internship, a literature review/study period was earmarked to better acquaint with Research Promotion and Development’s recent deliverable: a health research policy. In harmony with global developments in research for health, the Pan American Health Organization drafted a Policy on Research for Health in 2009 to set the foundation for the formulation of strategies and action plans that address the needs of the entire Region. [8] Approved at the 49th Directing Council, this Policy, CD49.10, made PAHO the first regional office of the World Health Organization to define a strategic approach aimed at using research to improve equity and development through strengthening NHRS. The documents reviewed during this period included but are not limited to: 1. the Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property (2011) [9] 2. the WHO Global Strategy on Research for Health (2012) [10] 3. Changing Mindsets: the Strategy on Health Policy and Systems Research [11] 4.
the ACHR report (2012) [12]
I also revisited the milestones for Research for Health Policy, updating the list available online in the Research Portal5 with more recent developments including but not limited to: 1. the WHO Global Strategy on Research for Health (2012) [10] 2. Changing Mindsets: the Strategy on Health Policy and Systems Research [11] 3. Research and Development to Meet Health Needs in Developing Countries: Strengthening Global Financing and Coordination (2012) 4. The World Health Report: Research for Universal Health Coverage (2013) 5. Essential Public Health Functions
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http://www.paho.org/hq/index.php?option=com_content&view=article&id=1690&Itemid=1658&lang=en
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Once there is a communications intern in HSS, the timeline on the Research Portal should be revised to include missing documents. He or she should prepare new graphics to accompany the PowerPoint currently on the website. In short, while other interns in the past conducted more in-depth analysis of National Health Research Systems, as there were no conferences taking place this year comparable to the Latin American Conference on Research and Innovation for health. When the need arises, those analyses should incorporate the newly revised milestones and indicators (to be described below).
B. Advancing the Draft of a Strategy and Plan of Action to advance the Policy on Research for Health The Advisory Committee on Health Research (ACHR) represents a component of the system of advisory committees within the World Health Organization. Comprised of experts from different backgrounds and disciplines, from science and technology to academia to knowledge brokering, members of the ACHR regularly participate in virtual debates and consultations in addition to yearly meetings called by the PAHO Director. In 2012, this advisory body reviewed the Policy on Research for Health accompanied by an outline of a strategy for implementation of this policy and offered in-depth suggestions for revision.
This original draft included comments regarding which sections needed to be
elaborated as well as suggested bullet points prepared by previous interns and their advisors in Research Promotion and Development prior to submission deadline. While the ACHR did review it for content, the draft was in no way ready for publication. The original working draft—available only in PDF format—was first manually transcribed into a Microsoft Word text document which was then edited for clarity. I then expanded the introduction to include notable global mandates and calls to action and illustrate the shift from health research to research for health. I also extended the background and context section to recommended length by including an assessment of the region in economic terms and inclusion of recent developments, including the 2013 Annual Report of the PAHO Director, and later revised the purpose and aim of this strategy to correct concerns raised by the ACHR. Ultimately, using other WHO strategies studied during the preparation stages of this internship, I drafted a section called ―Options for Actions,‖
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which identifies three to five measureable actions for each of the six objectives outlined in the original Policy. For the next draft of this strategy, it should be noted that original draft includes a list of indicators to measure implementation. They are removed in the meantime but should be reconsidered to be re-introduced in this strategy in a way that does not conflict or contradict with indicators of the evaluation Assessment Tool (to be discussed later in this Report). Additionally, if time permits, it is highly recommended to expand the regional ―Situation Analysis‖ to incorporate more data from WHO and the UN. While this advanced draft of the strategy fills in where the previous iteration left off, it needs to be reexamined once again by both Research Promotion and Development advisors and the ACHR before other, major changes.
C. Implementing and analyzing a survey for the implementation of PAHO’s Policy on Research for Health (CD49/10) in the PASB and Member States, providing a summary and instructions from future surveys In order to advance and facilitate the strategy and plan of action for PAHO’s Policy on Research for Health, and in so doing, to keep the Advisory Committee on Health Research abreast with relevant developments with this policy, the PASB devised an evaluation mechanism to characterize both PASB’s and Member States’ contributions to research, technical cooperation, investment and resources devoted to research. To that end, a team of advisors from Research Promotion & Development are in charge of coordinating the data collection and evaluation of policy implementation. This task has already been carried out for the PASB branch of the Organization. Using a survey consisting of approximately 15 questions designed by Dr. Luis Gabriel Cuervo, a previous Summer intern solicited implementation progress through correspondents with managers and the executive, mainly PAHO/WHO Representatives (PWRs), Area Managers (subsequently called Department Directors) and the Executive.
As such, this necessitates the
need for a means of assessing progress by Member States through their national health authorities. Adapting the methodology of the the Partnership Assessment Tool (PAT) originally developed for the British Government by the Leeds Institute for Health Sciences, the Assessment Tool (the Tool),
14 was conceived during this internship as a means of appraising progress in implementation of the Policy on Research for Health by Member States. First the six objectives of the Policy were extracted in the broadest sense. Each objective then lent itself through six abstract elements for a total of 36. While these elements are more relevant to the role that Member States carry in terms of implementation of the policy they are difficult to measure due the theoretical nature and must each be translated into actions, i.e. measurable statements. Hence, in the tool, there are a total of 36 statements, six for each objective
Objective (Broad) 6 total (Policy on Research for Health)
Elements (Abstract) 36 total (1 for every Objective)
Action (Statement) 36 total (1 for every Element)
This Tool ascertains from pre-selected respondents in Member States how far they would gauge these objectives to have been achieved in their country by indicating—to the best of the respondents’ knowledge—whether or not he or she agrees with the actions listed for each element. The assessment exercise is based on individual States identifying and sharing their views of the same Policy. As such, it reveals both areas of conflict and consensus and allows Member States to comment on the meaning and relative importance of their responses. Although the he methodology along with its questions was submitted to an initial review by various members of the PAHO ACHR and external peers, there needs to be a second consultation to review amendments included since the first iteration. Further, both the methodology and the tool must be translated into Spanish as the majority of respondents to be surveyed, i.e. designates in Science and Technology and health advisors in the national health authorities, and are predominantly Spanish speakers. This Tool must then be tested with prospective users and revised as necessary before launch.
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D. Assembling the research poster on “Online capacity building in translating research into practice for Latin American researchers� and workshop presentations Research promotion and development advisors attended the 2013 Canadian Cochrane Centre meeting in Quebec City this year. While the research and theory behind an online capacity building already existed, this information had to be collated and presented in poster format. After tabulating responses from a previous survey collected between 2010 and 2013 for a series of twelve webinars delivered to researchers in Latin America and the Caribbean, I organized this data into three tables and used Microsoft Excel coding to calculate relevant percentages and statistics. Following a prescribed Microsoft PowerPoint template, I arranged the Methods and Conclusions section into paragraph format, removed passive statements and submitted the draft for print. Additionally, in conjunction to preparing this poster, I assisted Mrs. Villanueva in preparing two presentations. One of these presentations was delivered by Blackboard collaborate which I assisted moderating from the WDC office.
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E. Research Interest Group (Two) Research Promotion and Development organizes monthly Research Interest Group (RIG) brownbag luncheons to facilitate an informal and collegial discussion fostering the exchange of information about research needs and interests. These meetings form a space for discussing challenges in health, best practices and novel ideas in research as an attempt to inspire innovation and collaboration in PAHO’s work. HSS invites researchers from outside the Organization coming from other national and international agencies including research universities, organizations, and collaborations. During the internship, I organized two Research Interest Groups. For my first Research Interest Group, I invited Dr. Francisco Cumsille, PhD, Coordinator of the Inter-American Observatory on Drugs of the Organization of American States (OAS) to discuss what Member States can do to further understand substance abuse in the Americas. Interns and staff alike then participated in a thought-provoking discussion on how substanceabuse in schools and prisons should be dealt with and examined the design of policies and programs that address illegal drug-abuse.
For the second Research Interest Group, I invited Dr. Cristina Rabadan-Diehl a Deputy Director from the National Heart, Lung and Blood Institute at the NIH to discuss the Global Health Office and the NHLBI’s Collaborating Centers of Excellence. These centers form a
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global network of research facilities that address chronic, non-communicable diseases in low and middle income countries. They instill a sense of responsibility at the country level while simultaneously building capacity and training future investigators and research administrators for health. The NHLBI therefore not only funds projects but also creates opportunities and new job prospects for new researchers within their home countries in order to combat chronic diseases under a sustainable model.
F. Art for Research Art for Research premiered at PAHO Regional Office for the first time earlier last month thanks to efforts put in by Dr. Luis Gabriel Cuervo and interns in Research Development and Promotion. A collection of images and art commissioned by PAHO visually demonstrate how research generates wealth and contributes to development and equity in health. This exhibit was previously on display in Canada, Spain, South Africa and New Zealand. Though scientific research advances our understanding of health in all its facets its returns are not immediately evident to most. Hence, the aim of the exhibits ―Shaping the World‖ by Theo Chalmers, ―Research in Movement‖ by Jane Dempster and ―Transformation for Development‖ by Shelly Xie is to reflect on the positive impact of good, evidence-based decisions made in the Americas and throughout the World.
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As the intern in charge of coordinating this exhibit, I met with managers from Governing Bodies and GSO to discuss placement and marketing. When the artist (Shelly Xie) arrived, I acted as her host during the directing council meeting.
G. Malaria Day in the Americas Report In November, PAHO commemorated its seventh annual celebration of Malaria Day in the Americas, chosen to coincide with the day in 1880 on which Dr. Charles Louis Alphonse Lavéran first identified malaria parasites in the blood of patients displaying symptoms of acute fever. Today, the event is a symbol of the Region’s commitment to relieve the burden of malaria in communities and coordinate efforts leading to its imminent eradication. The 2013 Organizing Team was collaboration between different departments at PAHO and also included 23 interns coming together from over ten different departments to learn more about malaria. I was assigned as a rapporteur for the event. The 12-page report I prepared in conjunction with other interns showcases three projects that have significantly contributed towards tackling the infectious disease. It outlines how interns united in solidarity through delivering a collective project where each individual played a vital role to put on an event that drew in decision makers, researchers, academics and funders.
H. (Ongoing) Research Paper on “Decision makers, scientific evidence and health policy decision making” International calls throughout the past two decades have attributed a more prominent role to research for health today. In particular, world leaders now begin to see research as a tool for addressing health inequities by reinforcing evidence-based health policies that take into account the needs of the most marginalized populations of the world today. This research paper I am helping to author under the supervision of Eleana Villanueva, Dr. Evelina Chapman and another intern seeks to elaborate on the impact of scientific evidence on health policy decision making. The paper gives an overview of how policies are dictated today as well as challenges and barriers that hinder evidence-informed policymaking. Through interviews with researchers, decision makers and a knowledge broker that mediates between the two sides, our research lies on the credence that when other decision
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makers hear from their peers and realize that it is indeed feasible to incorporate research evidence into decision making—and that there are tangible benefits that warrant the effort—then they are more likely to use scientific evidence more religiously. Through this opportunity, I had got the chance to network with both legislators in Member States and senior managers and PWRs in the Organization.
I. (Ongoing) Case Study – Revisit of Kangaroo Mother Care Oftentimes, babies born preterm or with low-birth weight are placed immediate in incubator hooked up to monitors, ventilators, and other mechanical contraptions. Not only are neonatal intensive care units (NICUs) loud and isolated, the separation between parent and child have been show to cause psychological stress and physiological changes for both. However, in recent decades, particularly in less developed countries in Latin America, there has been growing usage of Kangaroo Mother Care, an alternative technique of caring for a high-risk neonate originally conceived in response to overcrowding and inadequate resources for NICUs. Although a case study in the Research Portal already exists on Kangaroo mother care, my case study examines the surrogate outcomes that resulted from integrating this health service into neonate health care. According to Nathalie Charpak, daughter of the Nobel Prize-winning physicist George Charpak and internationally respected pediatrician whom I interviewed for this case study, Kangaroo Mother Care represents a way of humanizing neonatal healthcare. Since the baby is kept warm via a pouch in direct contact with their mother or father, the parent’s body now serves not only as the main source of warmth but also for feeding and stimulation. In this case study, I examine quantifiable neurological developments as well as more qualitative advantages that complement both traditional and conventional practices like breastfeeding. The evidence gathered serve as tools that can be used to convince policy makers to consider Kangaroo mother care as not only a way to treat preterm births but also a means of improving neonatal care.
J. (Ongoing) Networking and Visits In addition to technical projects, interns at PAHO are encouraged to network and engage in a variety of training and professional development opportunities. Additionally, they participate
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in team projects such as redaction and publications through social media and other medium for communication that the Organization uses. Over the past six months, during my time in Washington D.C. I have taken part in various networking events, including but not limited to:
Visits organized by PAHO (The World Bank, The International Monetary Fund, The Inter-American Development Bank, The Organization of American States)
Visits organized by my supervisor and peers (The Johns Hopkins Bloomberg School of Public Health, Inter-American Observatory on Drugs, The NIH, The NHLBI, The American Red Cross)
Visits organized by myself (The United States Capital—meeting with House Representatives, The US Federal Reserve, The Wilson Building—DC local government, The United Nations Headquarter in New York)
Additionally, I have also encountered, met with or exchanged business cards and/or research ideas with various dignitaries, decision-makers, senior PAHO executives and PWRs including but not limited to:
At PAHO(Dr. Francisco Bercerra-Posada, Dr. Carissa Etienne , Dr. Jon Andrus, Dr. Habib M. Latiri, Dr. Guillermo Troya, Commissioned Corps Officers)
Decision makers (Delegates of the 52nd Directing Council, Past President Álvaro Arzú of Guatemala)
Others (Peter Kyle—World Bank; Professors at the George Washington University; Professors at JHSPH, Kay Dickersin and Roberta Scherer; PAHEF; Janet Yellen—the Fed)
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V. Discussion (Assessment of the Internship) Undoubtedly, the firsthand experience mediated through the internship in a knowledgebased organization like the Pan American Health Organization gives me a preview of how international organizations operate and how they answer to international mandates and calls to action. As a graduate student studying international affairs and global health, I am interested in looking at public health from the policy side where global refers to not just geographical context but also in terms of scope and topic. Coming to PAHO, I expected to be assigned administrative tasks and duties to replace the administrative assistant that no longer works here but instead encouraged to take initiative and steer my own projects and research. Over the course of this experience, I realized that most of the time, I am completing the exact same tasks as consultants and temporary agents in the Organization. This is not to say that I was doing something that others were getting paid for; rather it reinforces the role that interns play in PAHO and delivers me an opportunity to experience my future career. Hence, my experience with PAHO thus far— as only an intern—far exceeds my initial expectations. As a training program, the internship provides a structural framework to match interns from diverse academic background with a technical specialty at PAHO in which their educational experience and comprehension will be enhanced through practical assignments and deliverables. This internship not only exposed me to the mission and objectives of PAHO but also provided me with invaluable input from various perspectives and specializations. The MDGs outlined in 2000 serves as testament to the systematic, inter-connected nature of health to development. By calling in researchers from other fields together, like Dr. Cumsille from the OAS or Dr. Rabadan-Diehl from the NIH, I explored public health from political and scientific angles. Likewise, through my temporary role as an intern assistant curator of the Art for Research galleries at PAHO, I juggled the idea of using other media to flesh out the returns of research, which are not always visible. In case of an exposition like ―Transformation for Development,‖ research—visually—becomes a driver of social and economic growth that tackles the socioeconomically determinants of health. In a similar way, a number of chronic diseases transcend national boundaries and require an international response from both medical practitioners on the field and legislators in the political arena. For example, although the polio vaccine technology is available, vaccination
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campaigns in Pakistan were not well-received until community and religious leaders adopted the idea. This ―global health diplomacy‖ highlights how technical expertise can better shape public policy and encourage community leaders to adopt better practices, minimize health disparities, and improve access to health. I had this tenet in mind when drafting the methodology for evaluating CD 49/10. The indicators through action statements gauges implementation based on how well leaders understand what goes on in their own country. Research closes the ―know-do‖ gap by identifying national priorities and then contrasting these to what actually goes on in the country. Before coming to PAHO, I worked as an analyst for IDDRI (Institut du Développement Durable et des Relations Internationales), Paris-based policy think-tank on sustainable development issues. Through qualitative interviews with stakeholders in food and nutrition security, including European lawmakers, NGO representatives, and development agencies (DFID, AFD), I discovered that international organs like the recently reformed Committee on World Food Security are able to act as a major forum of negotiations and debate where the scientific community can provide technical input. I hypothesized correctly that PAHO operates in a more extreme version of this model. In today’s world, it is advisable that not only health care providers and physicians make informed decisions but also policymakers and consumers. In order to achieve this propitious state, however, decision-makers need the best current evidence obtained through research and advocacy. As an intern in Research Promotion and Development, in addition to learning about the difference between health research and research for health, I joined community in dialogue to not only describe societal inequalities in health, but also explore the knowledge transfer opportunities and diverse interventions that drive health research towards human development. Although networking is something I have already done in the past, PAHO offered an opportunity revisit this skill and learn how to talk with people with far more experience than me. Rather than sequestering interns to a corner section the basement, HSS places them directly in juxtaposition to other researchers, consultants and managers on the floor. Proximity alone provides an environment that fosters networking. Likewise, attending important events at PAHO such as the 52nd Directing Council in October gave me a preview of policymaking from start to finish. While I intend to pursue a
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career in academia or research, I intend to produce evidence that guides decision making.
For
example, a resolution that addresses chronic renal diseases came about through research and assigns research a role beyond monitoring and evaluation, as an instrument that provides the framework for meaningful action.
Likewise, seeing indicators that measures research
governance in the PAHO Strategic Plan for 2014-2019 assures me that research continues to hold an essential function in public health and that my intended career has some form of insurances. Even though it is again a knowledge-based organization rather than a research institution, PAHO—both Member States and the Secretariat—are encouraged to base their work on research evidence. Seeing ambassadors, country representatives, and even a former President in the rotunda assures me that there is an audience waiting to read my work.
VI. Recommendations PAHO provides a friendly working environment with great mentorship, whether it comes from the supervisor, internship coordinator, or fellow colleagues. The administrative staff and assistants are fully supportive and generous but one challenge I encountered during my experience here is bureaucracy, in the sense that there are sometimes a lot of ―paperwork‖ to fill out or people to go through before achieving the intended goal. For example, first time room requests require registering for an account, followed by training, and then the actual request. Likewise, signing up for language classes follows a competitive process. As a result, the internship requires good time management and prioritization. It is a good idea to be familiar with administrative assistants—both in HSS and neighboring departments—who are more aware of resources at PAHO and exactly who to contact for service requests. PAHO is also a perfect environment for teamwork. I organized the first Research Interest Group alone which was successful but the second interest group where there was a communications intern present really made the session run smoother. Likewise, PAHO is a diverse environment where interns range from 20-43 years in terms of age and come from across the globe. It did not hit me right away that for some of the interns from Europe or Latin America, this was their first time living and working in the United States. Hence, we were ambassadors to one another, each representing his or her home countries.
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Reiterating the message that PAHO is a friendly place, it is encourage that interns make friends with each other right at the start.
VII. Conclusion The Pan American Health Organization through Research Promotion and Development seeks to advance the role of research in health systems at various levels. The internship at PAHO was therefore an opportunity for real-world experience in public health governance and application of materials covered in the classroom. Documents and global mandates pass at the international level to call attention towards the role of research in sustainable development, capacity building, and closing the ―know-do‖ gap. Through this internship experience, I explored the roles of health and research for health in addressing global health challenges and social determinants of health. I identified indicators and evaluation frameworks that assess governance, quality, ethics, and resource for health research. Likewise, I applied what I learned from formal education in the classroom to reports and briefings that will one day extend into policy. I intend to pursue a career in research through academia. Nonetheless, by offering a glimpse of how an organization such as PAHO or the WHO operates, this internship showed me how to frame work and communicate my research findings in a way that policy makers would appreciate and utilize. Undoubtedly, my goals in the future are to identify lesser known health interventions and services that have potential uses but are poorly executed or poorly disseminated. I believe that research can bridge the differences and ultimately make both this Region and this world, a happier, healthier place.
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Works Cited [1] WHA, "Role of Health Research, WHA Resolution 43.19," World Health Organization, Geneva, 1993. [2] PAHO, "Milestones for a Research for Health Policy," Pan American Health Organization, 7 March 2012. [Online]. Available: http://www.paho.org/hq/index.php?option=com_content&view=article&id=1690&Itemid=1658&lang=en. [Accessed 10 December 2013]. [3] General Assembly of the United Nations, "United Nations Millennium Declaration," in 55/2 United Nations Millennium Declaration, New York, 2000. [4] WHO, "Report of the Ministerial Summit on Health Research: Indentify challenges, inform actions, correct inequities," in Ministerial Summit on Health Research, Mexico City, 2004. [5] N. Pakenham-Walsh, "Learning from one another to bridge the ―know-do gap‖," BMJ, p. 329, 2004. [6] Bamako, "Bamako Call to Action on Research for Health. Strenghtening research for health, development and equity," in Global Ministerial Forum on Research for Health, Bamako, Mali, 2011. [7] PAHO, "Policy on research for health: document CD49/10," in 49th Directing Council, 61st Session of the Regional Committee of WHO for the Americas, Washington, DC, 2009. [8] PAHO, "Home - Research Promotion and Development," Pan American Health Organization, 7 August 2013. [Online]. Available: http://www.paho.org/hq/index.php?option=com_content&view=article&id=1688&Itemid=3796. [Accessed 10 December 2013]. [9] WHO, Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property, Geneva: World Health Organization, 2011. [10] WHO, "The WHO Strategy on Research for Health," World Health Organization, Geneva, 2012. [11] WHO, Changing Mindsets: the Strategy on Health Policy and Systems Research, Geneva: World Health Organization, 2012. [12] 44th ACHR Meeting, "Report of the PAHO/WHO Advisory Committee on Health Research," in 28th Pan American Sanitary Conference, 64th Session of the Regional Committee, Washington, DC, 2012. [13] N. Charpak, J. G. Ruiz, J. Zupan, A. Cattaneo and e. al, "Kangaroo Mother Care: 25 years after," Acta Paediatrica, vol. 94, pp. 514-522, 2005.