1. Abstract ID: 481 Author Name: Ebba Holme Hansen Email: ehh@dfuni.dk Presenter Name: Kumud K. Kafle Authors: Hansen EH, Kafle KK, Karkee SB, Onta SR, Subba S, Sthapit S, Kuschel R, Shrestha AB, Shrestha MP Institutions: The Danish University of Pharmaceutical Sciences; Copenhagen University, Denmark; and Tribhuvan University, Nepal Title: Project on Enhancement of Research Capacity in Nepal: Interventions on Primary Health Care Abstract: Problem Statement: The Nepalese research system partially lacks competence and capacity in terms of research in primary health care including drug use. There are also widespread problems in proper functioning of the health care system. Objective: To strengthen research competence at the university level through education up to the Doctor of Philosophy (PhD) level, with the goal to improve health care in Nepal. Design: Description of PhD graduates’ studies. Setting and Population: Health care system including primary health care facilities, and households from two hill districts. Three empirical studies in Jajarkot district and one study in Kathmandu district including 16 primary health care outlets, 99 modern health care providers, 10 traditional healers, 24 private drug sellers, 332 patients, 390 households, 207 married women of reproductive age (15- 49 years) and 64 key informants. Outcome Measures: Number of participants exposed to research methodology, number of local supervisors engaged in the research studies, number of university departments participating, number of PhD graduates, number of PhD theses supervised by PhD graduates, number of publications/presentations of research findings, number and type of issues uncovered. Results: Two research methodology courses were conducted in Nepal. There have been four local supervisors from four different departments for the four PhD graduates. The important findings are: community perception for illness socio- culturally constructed, health seeking behaviour of community people based on cultural world view, social interaction between the community and traditional provider more dynamic than with modern provider, different dimensions of women autonomy in household affairs and psychological factors like openness to change are contributing factors in fertility regulation, immunisation coverage in the district is exaggerated by over-reporting from primary health care outlets as well as district office, community knowledge is poor on immunisation, public sector is weak to manage the drugs including antibacterials, prescription drugs including antibacterials are available through unofficial sources like private bags and supervision/monitoring of service outlets very weak. Findings were disseminated through presentation to the policy makers and health care managers, and distribution of study reports/articles. Conclusions: The project has enhanced research capacity, promoted interdisciplinary research and revealed data on quality of drug systems and health care as well as community perception on health and service utilisation. The effort is effective to address the existing gap for the improvement of the health care system. Study Funding: DANIDA

2. 2 Background A pilot study on the pharmaceutical sector in Nepal, carried out in 1991-92, as well as the preparatory phase of the present project highlighted massive problems prevailing in Nepal with regard to both the activities and organisation of Primary Health Care (PHC) system and the scope and quality of research. Numerous donor organisation activities in the health sector in general did not comprise research. Local researcher training in PHC was not established. This project aims to bridge the gap. It was implemented in November 1993 and is on-going.

3. 3 Objectives To strengthen the research competence of university students in Nepal, the project focuses on researcher training up to PhD level. To direct the research students' projects towards PHC in Nepal, so that the results of the completed research may be implemented immediately in Nepalese health policy and in the practice of the health care system. To ensure the sustainability of the project, the project should last for 10 to 15 years and be implemented in a phased manner so that the results and experience of one phase will form the basis of the following phases. The intention is to establish a PhD programme in PHC at Tribhuvan University, Nepal.

4. 4 Design The project is an integration of two parallel development scenarios, i.e. a research training programme and an interdisciplinary research programme, topic of which is Primary Health Care. Training Programme The training programme has three components course on research methodology in PHC in Nepal, training of PhD students, establishment of a PhD programme in PHC in Nepal, including specialised research courses.

5. 5 PhD Programme A sandwich programme, the students are trained in Denmark as well as Nepal. Fieldwork and data collection entirely in Nepal. Theoretical courses in different institutions of Denmark. Data analysis, article and report writing in Denmark and Nepal. The Departments included – Nepal: Community Medicine and Family Health, Clinical Pharmacology, Sociology and Anthropology and Psychology, TU Denmark: Social Pharmacy (The Danish University of Pharmaceutical Sciences), Psychological Laboratory (CU), Epidemiology and Social Medicine (University of Aarhus), Department of Epidemiology (CU) and Danish Institute for Health Services Research and Development.

6. 6 Training on Research Methodology and selection of PhD students The first course was organised in 1994 and the second in 1997. Selection of participants for the training course included advertisement in national newspaper, radio and selection from the applicants based on qualifications and experiences. The selection of PhD students was primarily based on their performance during the course. The selection of students for PhD programme was multidisciplinary (health sciences, social sciences and the humanities).

7. 7 DisciplineNumber Social Pharmacy 2 Epidemiology and Public Health 2 Social Psychology 2 PhD students enrolled Number of participants in Research Course Results Year Number 199415 199716

8. 8 Research Projects

9. 9 Population Covered by Completed PhD Projects

10. 10 Issues Uncovered by the Completed Projects Community perception for illness socio-culturally constructed, Health seeking behaviour of community people based on cultural world view, Social interaction between the community and traditional health providers more dynamic than with modern providers, Different dimensions of women’s autonomy in household affairs and psychological factors like openness to change are contributing factors in fertility regulation, Immunisation coverage in the district is exaggerated by over-reporting from PHC outlets as well as district office, Health related data reported from health facilities less reliable Community knowledge on immunisation is poor Public sector weak to manage the drugs including antibacterials, Prescription drugs including antibacterials available through unofficial sources like private bags Supervision/monitoring of service outlets very weak.

11. 11 Dissemination of Research Results Publication of article7 Article under publication10 Conference/seminar presentation (international) 4 Policymaker/Planner3 Incorporation into curricula: undergraduate medical & public health, and postgraduate psychology Post-graduation Thesis Supervision7 PhD Thesis Supervision2 Other Research Activities6 Authority development (policy advocacy and promotion): promoted to higher and responsible positions Outputs following the Capacity Enhancement of PhD Graduates

12. 12 Conclusion The project has enhanced research capacity, and revealed data on quality of health care as well as community perception on health and service utilisation. The effort is effective to address the existing gap for the improvement of the health care system in Nepal.