Applying a new ethical toolkit for community engagement in health research priority-setting

Engaging communities in health research priority-setting is a key means of setting research topics and questions of relevance and benefit to them. But communities, especially those considered disadvantaged and marginalised, rarely have a say in the agendas and priorities of the very health research projects that aim to help them.

How can researchers and communities share power and ownership when setting priorities for health research projects? An “ethical toolkit” is being developed to help researchers and their partners design inclusive priority-setting processes for health research projects. The toolkit places community engagement and power-sharing at the heart of health research priority-setting. It is a reflective project planning aid for use before priority-setting is undertaken for a health research project. It consists of 3 worksheets and a companion document.

In today’s workshop, the ethical toolkit will be introduced to workshop participants and they will be able to give comments and feedback. Then workshop participants will have the opportunity to apply the toolkit to their current/upcoming health research projects in small groups. (The toolkit is currently not publicly available but will be provided to participants at
the workshop.)

About the speaker

Dr Bridget Pratt is a Research Fellow in the Centre for Health Equity at the School of Population and Global Health at the University of Melbourne. Her work focuses on the ethics of global health research and health systems research, with a focus on social and global justice. She develops ethical guidance
for global health research in relation to multiple areas: priority-setting, governance, capacity development, community engagement, provision of ancillary care, research translation, benefit-sharing, and data sharing.

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Unpacking Interventions

Dr. Pragati Hebbar will be presenting a seminar on the topic ‘Unpacking implementation’.

As part of her early career Wellcome trust/ DBT India Alliance fellowship she is undertaking an ‘Implementation research for taking tobacco control policy interventions to scale in India.’ One of the first steps in this endeavour is to unpack ‘implementation’ and related concepts / models / theories / frameworks and define it for this project purpose. Through this seminar she would like to share her readings and thoughts on the topic of implementation and garner feedback into how she has situated the same in her work.

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Enhancing the role of community health workers in service utilisation of tribal populations

While great gains have been made in both understanding and eradicating disease burdens for indigenous populations, health systems studies, and studies assessing service utilization and delivery are limited. Further, Community Health Workers, or ASHAs, have helped in improving maternal and child health outcomes as well as reducing the toll of infectious diseases – the very service areas where tribal populations face great barriers. Given the recent focus on universal health coverage reform, and the recommendations of expert groups, there is a need to more deeply enhance and improve the contribution of CHW programmes in service of tribal health needs. In this study, we draw attention to tribal minority populations in the Nilgiri Biosphere Reserve region, spanning the southern Indian states of Karnataka and Kerala. Notwithstanding that both states have relatively strong health systems, by virtue of being a small and relatively isolated, tribal populations have limited access to programmes and services– they are being left behind. The methods used in this study include key informant and in depth interviews, focus group discussions in close coordination with local implementer groups and government agencies.

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Eleventh webinar in the Equilogues series

The Health Equity Cluster at IPH Bengaluru is now the secretariat for the newly launched Health Equity Network India (HENI) and is pleased to announce the eleventh webinar in the Equilogues series in January 2019. Do block your calendar for this date and come join us in an engaging conversation on health inequities in India.

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Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana

Since its announcement in Budget 2018, Ayushman Bharat has received considerable attention. It aims to achieve universal access to primary, secondary and tertiary healthcare through its two component: Health and Wellness Centres and Pradhan Mantri Jan Arogaya Yojana (PMJAY). This presentation by Ketki will give a brief overview of the design and implementation of PMJAY, a financial protection scheme which aims to cover 10 crores vulnerable families.

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Sharing power with communities in health research priority-setting

As a matter of health and social justice, health research should improve the health and well-being of those considered disadvantaged and marginalised and foster their engagement in all phases of its conduct. Such communities’ engagement in priority-setting is a key means for setting research topics and questions of relevance and benefit to them. However, without attention to dynamics of power and diversity, their engagement can lead to presence without voice and voice without influence. What is needed to give marginalised communities a voice in agenda-setting for health research projects? In this talk, Bridget will present the findings of conceptual and empirical research that address this question. Key ethical considerations for sharing power with community members that should be taken into account before, during and after priority-setting will be identified and discussed.

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Strengthening Primary Health Care through Informal Healthcare Providers

It has been estimated that over 80% of the world’s population depends on traditional healing systems as their primary source of care. Traditional Medicine consists of codified and non-codified streams of knowledge. The Foundation for Revitalization of Local Health Traditions (FRLHT), Bengaluru is currently operating a National Scheme along with the Quality Council of India (QCI) for the Assessment, Training and Certification of Traditional Community Health Practitioners based on a standards competency model aligned with ISO 29990 and ISO 17024 which looks at applying stringent rigors for the process of training and certifying TCHPs.

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IPH Annual Day Oration Series

"As part of the IPH Annual Day celebrations on September 1 (2018), we launched an IPH Annual Day Oration Series. The purpose of this series is to hear from distinguished professionals and leaders talk about their journey, experiences and perspectives that...

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Health Technology Assessments

A brief description of what HTA is, how it is done, how to interpret such studies and a discussion on whether this might be relevant for India.Dr. Neethi RaoIPH Honorary Associate15-November-20184:00 pm - 5.00 pmInstitute of Public Health, Bengaluru 3009, II-A Main,...

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World Antibiotic Awareness Week

The Antimicrobial Stewardship cluster of the Institute of Public Health promoted the “World Antibiotic Awareness Week” from 12th – 18th of November through a series of academic sessions conducted at select Pharmacy colleges, Hospitals and Schools, on themes corresponding to each day of the week as listed out by WHO. The sessions dealt with strengthening awareness regarding indiscriminate Antibiotic usage, infection prevention and control aided through WASH, One Health approaches incorporating interventions for environment and animal health etc. The events were aimed to sensitize the target audiences on current gaps in practice and roles and opportunities for intervention. The week-long events culminated with a colloquium on strengthening antibiotic stewardship through coordinated research and development, organized at IPH, with the participation of resources from NCBS, Al Ameen College of Pharmacy, KLE College of Pharmacy, Karuna Trust, Sri Devraj Urs Medical College Kolar, Molecular Solutions Care Health, Acharya Institute and PCMH restore health.

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Mapping parliamentarians who are concerned about tobacco

This project aimed to map and analyse the elected representatives of Indian parliament,who participated in Lok Sabha and Rajya Sabha debates and also raised queries about tobacco.Abirami KaliyaperumalIPH Intern26-October-20184:00 pm - 5.00 pmInstitute of Public...

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Tenth webinar in the Equilogues series

Institute of Public Health Bengaluru is pleased to announce the tenth webinar in the Equilogues series which was started by the Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology as part of their projet Closing the Gap: Health Equity Research Initiative in India. Please find attached the webinar announcement for the same.

Theme: Inclusion of minorities in public services in India

Upendra Bhojani at the Institute of Public Health (Bengaluru) led the India part of a multi-country collaborative project that aimed at building local network of researchers/practitioners/policymakers that can address social inclusion of ethnic and religious minorities in public services. Drawing on the findings from a scoping review of literature and a series of stakeholders consultations in Karnataka, he will briefly highlight the role of inclusive policies (esp in areas of education, health, governance, employment) in enhancing inclusion of minorities as well as gaps in our knowledge.

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Antimicrobial Stewardship at Karuna Trust’s PHCs – Situational analysis of antibiotic usage and Medicines and Therapeutic Committees

Antimicrobial Stewardship (AMS) is the new cluster at IPH that is being initiated by Sunitha. As part of this process, the first project is to incorporate AMS at 26 Karuna Trust Primary Health Centers (PHCs) in Karnataka by strengthening the Medicines and Therapeutics Committee (MTCs). An IEC application is being written up to seek ethical approval for the situational analysis phase of this project which aims to conduct a baseline study by documenting the current policies and practices that govern the pharmaceutical supply management of antibiotics at these 26 PHCs. Following the current prescribing indicators, including the prescribing pattern of antibiotics, the subsequent phase is designed to gather data on the Medicines and Therapeutics Indicators (MTI) for their PHC based contextual relevance before they could be incorporated as part of the Health Management Information System during the subsequent intervention phase of the project. This presentation is to seek feedback from peers at IPH so the IEC application is tweaked accordingly before submission on 15th Oct.

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Health Inc. project

Mahesh will present an introduction to the Health Inc. project, the methods and the SPEC framework used in the project.

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RSBY awareness study findings

India’s health care is predominantly financed by households through out-of-pocket payments at the point of care. Recognising this, successive governments have introduced various measures including health insurance schemes to protect the poor from high hospitalisation costs. One such scheme introduced in 2008, was the Rashtriya Swasthya Bima Yojana (RSBY). Meant for the poorest of the poor, the government subsidised the premiums so that patients from this population are able to get free hospitalisation care at select hospitals in their neighbourhood. Despite a 100% subsidy of premiums and the promise of free health care even in private hospitals, in 2011-2012 the enrolment rate in RSBY was 51.4%. The aim of our study was to identify the reasons for the poor enrolment.

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Debate: Purchasing primary care from the private sector is neither feasible, nor should be attempted for a country like India

This week, IPH has organised a debate on the topic ‘Purchasing primary care from the private sector is neither feasible, nor should be attempted for a country like India’. Dr. Prashanth will speak in favour of the topic (Affirmative) whereas Dr. Devadasan will speak against it (Negative). The speakers get 8 minutes each for their constructive speeches, followed by a second round (4 mins each) for rebuttal. A moderator will keep time. Pre- and post-debate audience polls will be held.

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Developing effective payment platforms for accessing public finance in Zambia: Presentation and Q&A with Dr Kajal

Dr. Kajal shares with us findings and lessons learnt from her research in Zambia that looked at developing effective payment platforms for accessing public finance. This was qualitative research with different stakeholders from the Churches Health Association of Zambia (CHAZ) and public sector ministry of health at state and provincial levels. The findings may be relevant to Low and Middle income countries such as India.

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Ninth Webinar in the Epilogue Series

Closing the Gap: Health Equity Research Initiative in India of the Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology is partnering with the Cluster on Health Equity at the Institute of Public Health Bengaluru to announce the ninth webinar in the Equilogues series.

Theme: Denial of reproductive health rights of Particularly Vulnerable Tribal Groups (PVTGs) in Chhattisgarh

Speaker: Sulakshana Nandi, State Convener of Public Health Resource Network, Chhattisgarh.

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Review Methods

This seminar is structured differently. 3 speakers (Prashanth, Tanya and Nityasri) will make presentations of 15 minutes each on related topics. All research begins with a review of literature. In this seminar, the three speakers will each present a different review method – realist synthesis, critical interpretative synthesis and systematic review, respectively.

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Implementation research for taking tobacco control policy interventions to scale in India

Tobacco kills approximately six million people globally and over one million adults in India each year. In India, a comprehensive tobacco control law the Cigarettes and Other Tobacco Products Act (COTPA) 2003 exists. However, the implementation remains sub-optimal. COTPA has worked in some places/contexts/settings and not in others. From a policy and implementation perspective, it is crucial to systematically understand how and why the implementation of this law has occurred. By doing this, we will improve our knowledge of implementing effective tobacco control policies (TCPs) as well as identify system-wide implementation bottlenecks that could affect other sectors like pharmaceutical/food. I aim to improve the implementation of TCP in India by describing and explaining the why and how of its implementation across Indian states. Some of the hypotheses include: a) Champions at either political or bureaucratic level facilitate policy making and implementation process b) Implementation is weakened when restrictive mandates are provided to departments who are not involved in punitive action. The study will be conducted in five phases using quantitative and qualitative methods to map implementation landscape and using theory-driven inquiry to draw lessons. The purpose of this seminar is to seek suggestions to improve the proposal and shape the work that I will be doing over the next 5 years as part of my early career India Alliance fellowship.

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Deciphering an epidemic of epic proportion: the role of state and tobacco industry in tobacco control in post-liberalized India (1990-2017)

In this seminar, Upendra Bhojani will present an overview of the research he aims to conduct as part of the India Alliance fellowship for the next 5 years. The purpose is to seek comments/suggestions/critique for refining the proposal. About 3500 Indians die every day due to tobacco-attributable illnesses. Despite several regulatory measures, there has been a marginal decline in tobacco use in the last two decades. In fact, since 1990s, tobacco production and sales have increased. Therefore, this research aims to understand the role played by the state policies (related to tobacco) and the tobacco industry actions during 1990-2017. I will conduct the study in three phases. In Phase-1, I will map public policies related to tobacco in this period. In will use quantitative data to explore associations between the tobacco policies and the trends in tobacco production and consumption. In phase-2 I will use qualitative data to understand how the tobacco industry actors influence tobacco policies in India. How do governments in India respond to the industry influence as well as their own varying (often conflicting) interests in tobacco? Based on these insights, in the phase-3, I will select ten Indian states: five positive (significant decline in tobacco prevalence over time) and five negative (status quo or increase in tobacco prevalence) cases. I will use qualitative comparative analysis to understand the combinations of measures (policies, implementation, tobacco industry) that best explain a significant reduction in tobacco use prevalence.

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A Comparison of the National Guidelines of the VL Elimination Programme in India, Bangladesh and Nepal

Visceral Leishmaniasis (VL) is an infectious disease predominantly transmitted by the sandfly. 90% of the cases of VL in the world occur in Brazil, Ethiopia, South Sudan, Sudan, India, Nepal, and Bangladesh. In 2005, the WHO South East Asia Region, responding to increasing incidences of VL in the Indian subcontinent, initiated a VL elimination program within India, Bangladesh, and Nepal. The aim was to reduce the incidence of VL to <1 case per 10,000 cases in districts/subdistricts within the three countries by 2015. Since then, the goalposts have shifted from 2015 to 2017 and, now, to 2020. Nepal and Bangladesh have traveled much further on the road to elimination than India has, Nepal having sustained the elimination target in the 12 once-endemic districts since 2012. In 2016, Bangladesh reached the elimination target in 99% of its endemic subdistricts (upazilas). Lagging closely behind, India has reached the elimination target in 85% of endemic subdistricts. The aim of this literature review predominantly on the national guidelines of VL elimination/control in the three countries as well as some research articles on the same is to compare the program in India with Bangladesh and Nepal, to identify similarities and differences between the programs, and to extrapolate data to see how India can learn from Bangladesh and Nepal to hasten its pace towards elimination of VL.

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GIS Mapping of Private Sector Medical Facilities in Karnataka

There is very little information currently available about the private sector in India. This project aimed to develop a profile of all the private sector medical facilities in the state of Karnataka, particularly in the context of the recently announced Aarogya Karnataka scheme by the Government of Karnataka.

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Tobacco Control Project – Mapping Policy Concerns

Understanding public policy around tobacco use is required to understand the conflicts of interests of state and non-state actors in India. My work revolved around mapping concerns on tobacco expressed as debates by the parliamentary elected representatives by sourcing the official archives of loksabha and rajyasabha.

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Prices of medicines for Visceral Leishmaniasis : Identifying the current issues

WHO identified Visceral Leishmaniasis (VL) as a Category I disease (emerging and uncontrolled) and the support to the Elimination control programs in India, Nepal and Bangladesh were intensified in 2005. One of the key approaches that allows accelerated efforts towards the elimination process is by focusing on availability, affordability and accessibility of medicines used to treat VL. This presentation by Ms. Aishwarya Kulkarni, who has completed her BPharm, focuses on the evolution of the medicines for VL, their prices and some of the current issues in this regard.

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