Department of Health Services Provision - World Health Organization - Geneva Elena Varavikova, scientist, Department of Human Resources for Health Evidence and Information for Policy Health Research for the Population Health improvement – building capacities

Department of Health Services Provision - World Health Organization - Geneva Health research - definitions "Research is a system involving people, Institutions and processes. Its pursuit depends on systematic analysis, creativity and exploration" (Comission on health Research for Development, 1990)

Department of Health Services Provision - World Health Organization - Geneva Challenges for Kazakhstan MDG by 2015 State Program on reform and development of Public Health of the Republic of Kazakhstan Population Health analysis and improvement (LE, Infant & maternal mortality, CVD; etc) Monitoring and Evaluation of the health system Research, education and training

Department of Health Services Provision - World Health Organization - Geneva Working in the Public Health Field Survey methods Evidence-based recommendations, info. Continuous education Planning Working with expert advisory group Team building Maximising health gain with available resources Working conditions

Department of Health Services Provision - World Health Organization - Geneva Who are doing the job of population health analysis and evaluation? Education and Training? MOH ? National Public Health Institute? Health leaders? Politicians? Professional Associations? NGO's, Donors? Who are working in this area and who prepared them? System of continuous education – available?

Department of Health Services Provision - World Health Organization - Geneva WHO Knowledge for better Health - " know-do " gap Research is an investment, not a cost A broader, more inclusive view of health research is needed Research should be applied to improve health equity Research must be conducted according to universal ethical standards Knowledge derived from research must be accessible to all Civil societyhas a vital part to play in setting resear

Department of Health Services Provision - World Health Organization - Geneva Acute care hospital admissions per 100 Source: WHO/Europe, HFA Database, January 2005 Kazakhstan Kyrgyzstan Russian Federation Tajikistan Turkmenistan Uzbekistan EU

Department of Health Services Provision - World Health Organization - Geneva Live births per 1000 population Kazakhstan Kyrgyzstan Russian Federation Tajikistan Turkmenistan Uzbekistan EU

Department of Health Services Provision - World Health Organization - Geneva Autopsy rate in %, for hospital deaths

Department of Health Services Provision - World Health Organization - Geneva Source: WHO/Europe, HFA Database, January 2005 Kazakhstan Kyrgyzstan Russian Federation Tajikistan Turkmenistan Uzbekistan EU SDR, diseases of circulatory system, 0-64 per

Department of Health Services Provision - World Health Organization - Geneva SDR, cerebrovascular diseases, 0-64 per

Department of Health Services Provision - World Health Organization - Geneva SDR, trachea/bronchus/lung cancer, 0-64 per Source: WHO/Europe, HFA Database, January 2005 Kazakhstan Kyrgyzstan Russian Federation Tajikistan Turkmenistan Uzbekistan EU

Department of Health Services Provision - World Health Organization - Geneva Role of PH Professional To study, understand and report on the scale of the health situation and to raise public and political awareness To interpret patterns of health and morbidity e.g smoking, alcohol, social dislocation To advise on what should be done, drawing on best available evidence of effectiveness of interventions from different settings e.g. folic acid, community vs. hospital care To monitor the impact of new policies, adapting them for changing circumstances

Department of Health Services Provision - World Health Organization - Geneva Understand Social Determinants of Disease and Outcomes Lifestyle issues e.g. smoking, diet, exercise Societal issues e.g. unemployment, family income Complex mechanisms e.g. transition and self image Widening social and regional inequities Crucial roles of education, pensions, social policy, political economics, health policy Partnerships to deal with complexity Analysis and monitoring What can the health system do to alleviate the negative results of individual and societal states?

Department of Health Services Provision - World Health Organization - Geneva Political and Societal Context Shift toward market economy Reduced job and societal security Administrative decentralization (vs decapitation) Undervaluing of health e.g. health expenditures as % GDP under 5% vs. 7-9 % in industrial countries Reduced role of the state Switch from Semashko to Bismarckian models Stress on individual responsibility Role of the hospital oriented health system vs. shift to community oriented system

Department of Health Services Provision - World Health Organization - Geneva What’s outside of the SPH’s walls? Globalisation; social and economics instability Changing role of the National Health Systems Health Threats: HIV/AIDS, TB, Malaria... Macroeconomics and Health 10/90 and Health Research Evidence-based decision-making

Department of Health Services Provision - World Health Organization - Geneva What are objectives of KSPH ? Centers of excellence – training, research, service International standards and participation Academic independence i.e. not a function of state Attractive to students and stakeholders Sustainability Culture of quality Acceptance by graduates and faculty Accountability and reward - not by hours but program and results Internal and external peer review

Department of Health Services Provision - World Health Organization - Geneva Potential Contribution of Schools of Public Health Train people (skills and competencies) to: Train people (skills and competencies) to: Analyze health system and PH problems Analyze health system and PH problems Develop evidence-based policies Develop evidence-based policies Assist governments in re-alignment of health priorities Assist governments in re-alignment of health priorities Work with public and private sector Work with public and private sector Research and develop tools to deal with new issues, e.g. globalization, communications technology, internet Research and develop tools to deal with new issues, e.g. globalization, communications technology, internet Continuous professional and public education Continuous professional and public education Develop policy, programs, models and actions driven by national and community needs (e.g. poverty and inequity reduction) Develop policy, programs, models and actions driven by national and community needs (e.g. poverty and inequity reduction) Create a demand for professionalism in public health Create a demand for professionalism in public health

Department of Health Services Provision - World Health Organization - Geneva Role of Research in SPHs  Set standards of evidence from past and current international experience  Identify avoidable morbidity/mortality in individual and population health  Identify individual and societal risk factors  Explore ways to prevent disease and promote health  Find the ways of improving primary prevention and delivery of health services (efficiency, effectiveness, evidence-based)  Promote quality in management in health systems

Department of Health Services Provision - World Health Organization - Geneva Research Capacity development Careful selection of trainees Capable scientific leadership Continuity of research funding Good equipment Supplies in the institutions including communication facilities

Department of Health Services Provision - World Health Organization - Geneva Research in SPHs Publications in local and international peer reviewed scientific journals Publications in local and international peer reviewed scientific journals Develop culture of peer review and a self-critical attitude (Research Forum) for students and faculty Develop culture of peer review and a self-critical attitude (Research Forum) for students and faculty Disseminate findings to those who can benefit Disseminate findings to those who can benefit If in national language, abstract in English invites comment and criticism from a wider audience If in national language, abstract in English invites comment and criticism from a wider audience If funding of a SPH is tied to teaching hours, need to provide incentives and time for active research to be valued and rewarded If funding of a SPH is tied to teaching hours, need to provide incentives and time for active research to be valued and rewarded

Department of Health Services Provision - World Health Organization - Geneva Conclusion High mortality and morbidity from preventable diseases cannot be addressed without training large numbers of public health professionals High mortality and morbidity from preventable diseases cannot be addressed without training large numbers of public health professionals Need for research impossible overestimate Need for research impossible overestimate Attention to the cadres Attention to the cadres Needs time, resources, international support, and adaptation from successful experience to local circumstances Needs time, resources, international support, and adaptation from successful experience to local circumstances