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 long-standing 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

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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 Facilitators & resource persons

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.

John Frank

Hawkes – Masumbuko

Reducing the burden of illness due to malaria through a Community Driven Development (CDD) strategy in the Democratic Republic of Congo (DRC).

Erica DiRuggiero

Webb-Quizpe

Mercury in rural Ecuadorean and Peruvian households: social and geographical distribution; and the role of deforestation, road construction and oil exploitation.

Enrique Cifuentes

Espinoza-Pantoja

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.

Lori Hanson

Brewster-Mohammed

The role of the Malaysian pharmacy profession in smoking cessation in Malaysia: adapting training programs, promoting professional leadership, and initiating and conducting related research.

Narayana Delampady

Kakuma – Klentjes

Mental Health and Poverty Project (MHAPP): factors in mental health policy development and implementation, in four African countries: Ghana, South Africa, Uganda and Zambia.

Oyunaa Lhkvagasuren & Subrata Mukherjee

Martin – Kiweewa

Outcomes of HAART among HIV/AIDS patients in Fort Portal, Uganda: treatment patterns; adherence patterns; outcomes; and outcome predictors.

Lydia Kapiriri & Salim Sohani

Delfin – Robillard

Political violence, natural disasters and mental health outcomes: developing innovative health policies and interventions: related to the armed conflict between the

Jeff Reading

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Shining Path, the Peruvian government and Quechua communities in the Peruvian highlands.

Michael - Daley

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