19.11.2008
UCC staff travel to Ethiopia and Uganda to identify and strengthen weak linkages between formal health systems and community based health systems in developing countries.
In order to facilitate an increase in its support for health research, with a particular emphasis on collaborative projects involving the Irish research community, the Department of Foreign Affairs, through its official assistance programme, Irish Aid, signed a Memorandum of Understanding with the Health Research Board (HRB) in October 2005.
A call by the HRB for Global Health Research Awards during 2006 was the first joint initiative resulting from the Memorandum of Understanding with six projects funded at a total cost of approximately €2 million. However, it was noted that many of the research proposals were not seen to be in line with the needs of developing countries themselves.
As a result, a series of networking grants were awarded, up to a maximum of €10,000 euros each, to allow researchers in recognised research institutions in Ireland to build relationships with their counterparts in developing countries and with other collaborators in order to collaboratively develop research proposals for submission to future HRB and other grant competitions in the global health field.
The grants were awarded to facilitate the further development of a specific research concept. The following is a report on a trip toUgandaandEthiopiaunder this particular award and the research concept was based on identifying and strengthening weak linkages between formal health systems and community based health systems in developing countries.
Summary of Main Findings from Visits:
1. Research: Reactions to research topic and prospective collaborators:
Overall, all the colleges expressed interest in the research topic stating that it was highly relevant to the country situation.
1. Mekelle University, Tigray and Tigray Regional Health Bureau
The health sciences college in Tigray has already made out a list of its research priorities which predominantly focus on HIV/AIDS, malaria, TB, drug efficacy and quality and other systems issues. The specific topic of research was apparent on their list but interest was expressed in given the presence of the health extension programme in their region.
Dr. Gebreab Barnabas who is the Head of the Regional Health Bureau serving the population of this region, was supportive of the idea of an evaluation of the health extension package. He personally feels that it has been very successful in improving the coverage of health services in the region and cited the accelerated numbers of those with HIV who have been tested and are on antiretroviral therapy due to the major contribution of this new cadre of community health worker.
He also pointed out how those with higher degrees such as Masters in Public Health and PhDs, often use this higher qualification as a ticket to exit the region and work in the capital or overseas. His preference is for task shifting and training of middle level health workers with a particular emphasis on epidemiology and biostatistics.
1. SNNPRS – University of Hawassa and Regional Health Bureau
Again the University of Hawassa, College of health sciences has a list of research priorities, many of which are funded using government grants. They felt that the research project was very appropriate and would like to be involved.
The Regional Health Bureau expressed strong interest in an evaluation of the health extension worker programme. They have recently trained supervisors for the health extension workers but acknowledge that given a lack of transport and allowances for the trained supervisors to get out and do what they have been trained to do, there may be deficiencies in the programme.
2. Irish Aid Ethiopia
Of most interest, the head of development in Irish Aid reaffirmed that the proposed topic of research is in line with Irish Aid’s country strategy paper and that Irish Aid are very interested in an evaluation of the health extension programme being carried out. While funding has already been earmarked to support such an evaluation, Irish Aid have agreed with other development partners in Ethiopia that any proposed research would only be considered jointly.
In terms of being representative of the country as a whole, the SNNPR with its large population and various tribes and languages would be a more appropriate research setting for the proposed work over Tigray region, which has one main language and ethnic group.
3. Malaria Consortium
Malaria Consortium Ethiopia has some money budgeted to supporting the health extension package in SNNPR and may be able to provide logistical support if a partner on the proposed research.
4. Makerere University School of Public Health (MUSPH)
Dr. George Pariyo, senior researcher in MSUPH reaffirmed that the area of research was pertinent to Uganda given the number of Ministry of Health programmes that have a community component. The Village Health Team is the preferred structure for community delivery of health interventions but this concept, while successfully piloted in a number of districts has to date, only reached coverage in 50% of districts. The approach, which sees large village teams (1 community health worker per 25-30 households) is quite expensive to initiate and maintain.
5. Mbarara University of Science and Technology
The dean of this school, Dr. described an ongoing project of training community health workers and coordinators who are responsible for the health of villages in 2 sub counties (administrative units with about 20,000 population) in Mbarara district and an adjoining district. This model is similar to the Village health team model but with a lower number of health workers per household grouping – 2 village health workers per village. It was felt locally that this more lean arrangement was more sustainable than the national model due to less costs involved intraining and in follow up support supervision.
Therefore, the proposed research could examine this model side by side with the village health team and other delivery models.
6. Malaria Consortium (MC)
The MC Africa regional office is in the late stages of developing a project that will see community treatment of a number of the top causes of morbidity and mortality in Uganda, South Sudan, Ethiopia and Zambia. This proposed project provides a potential funded projects on which research related to community structures and their linkages to the formal health services could be piggy backed with benefit to both the MC and any UCC led research group.
7. Irish Aid Uganda
Mr. Donal Cronin, Acting Head of Development, Irish Aid Uganda, gave an overview of the Irish Aid programme in Uganda. Irish Aid is supporting is not supporting the health sector directly in Uganda. Rather, it gives indirect support through funding of various Irish and international NGOs as well as funding to Human Resources for Health channelled through the African Medical Research and Education Foundation (AMREF) who assist a number of health training colleges for middle level health workers. Irish Aid also supports the response to the HIV/AIDS epidemic which is partly through the health sector but also many other sectors.
The Irish Aid country office in Uganda will only support projects and research relevant to the sectors it is focussing on.
2 Teaching: Potential Partner Universities for Exchange Visits
All universities visited would welcome inputs to their teaching courses. However, of all the universities, the Mountains of the Moon in Uganda and Mbarara University would be stronger potential partners for the Department of Epidemiology and Public Health. The medical school may be in a position to assist both of the universities in Hawassa and in Tigray given their more pressing need to support training of clinicians and up skilling of middle level health workers to fill the void left by a lack of medical doctors in rural areas of Ethiopia.
Mekelle College of Health Sciences, University in Tigray is about to start a Masters in Public Health. However, it has already 2 partners identified – a private university in Addis Ababa and Tulane University in New Orleans. The college also has a school of pharmacy that would welcome support from UCC.
College of Health Sciences, University of Hawassa would welcome support to teaching. Of special interest is support to some of their clinical training – obstetrics, paediatrics and general medicine. As of yet, no MPH is running in the university but plans are already underway to initiate one.
Makerere University School of Public Health: This schools is already well established with a long list of international partners.
Mbarara University of Science and Technology: A new MPH course has just started here. The most pressing need of the university is expansion of its current infrastructure. Only 2 classrooms are available and all offices are shared with the nursing schools. These offices are particularly overcrowded. The intake of the MPH is limited by space in which to teach the students. UCC may be able to seek support for infrastructure development in order to allow the expansion of the MPH course.
Mountains of the Moon University, Fort Portal, Western Uganda
This university is recently established. Assistance has been requested in the development of the curriculum and in teaching its BSc programme for Public Health. As UCC is the only university in Ireland to run such a programme, we are ideally positioned to assist the Mountains of the Moon.
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