|
Indian Pediatr 2011;48:
181-182 |
|
Synthesizing Evidence for Improving Child
Health in India |
K Srinath Reddy and Henri van den Hombergh*
From Public Health Foundation of India and UNICEF-India*;
New Delhi, India.
Correspondence to Dr Henri van den Hombergh,
Chief-Health, Unicef-India, 73, Lodi Estate, New Delhi, India.
|
Historically, research and evidence have played a significant role in
designing interventions for improving child health. Research on cholera
patients in Bangladesh leading to development of Oral Rehydration Salts
(ORS) is one of the most illuminating examples of the contribution of
research to a potent public health intervention that has saved many
children’s lives since then [1]. Similarly, identification of the
hand-pump as the source of a cholera outbreak in London led to strategies
to the control of one of the most feared scourges in the history of
mankind [2]. However, the coverage of many such interventions remains low
among populations that most need them. For example, extending the ORS
example, only 43% of children with diarrhea received ORS in the last two
weeks in India [3]. There is also a growing apprehension that with
increasing integration of programs, the focus on expanding coverage of
specific interventions has reduced, leading to dwindling coverage of the
known interventions. As a result, decline in child mortality in India
remains slow, not sufficient to meet the commitments of Eleventh Five Year
Plan or to achieve the Millennium Development Goal.
What then can the research and researchers do? Well,
several things. First, synthesize data and present fresh information on
the continued presence of the problem. Diarrhea and Pneumonia still
kill children in India. Second, synthesize data and present fresh
information on what saves lives. Old information becomes dated and stale.
Policy needs to be reinfused and programs to be reinvigorated with new
data. ORS still save lives. Adding zinc hastens recovery and reduces
further episodes. Third, synthesize data and present fresh information
on (lack of) progress in expanding coverage of the known interventions.
Coverage of ORS and antibiotics for pneumonia remain unacceptably low in
India. Fourth, synthesize and present evidence on gaps in the current
knowledge to inform the research agenda. We do not even know which
organisms cause diarrhea and pneumonia in India. Fifth, synthesize
current information on the barriers and enablers for expanding coverage of
existing interventions. Children still die due to pneumonia because
health facilities are far away and community health workers are not
clearly empowered to treat these children [4]. Sixth, synthesize
global evidence on what works and what does not? As reported in the paper
on review of evidence on acute respiratory infections in this series,
management of childhood pneumonia by community health workers in Nepal,
some two decades ago, helped reduction of under-five mortality by as much
as 28%. [5].
Finally, and most importantly, communicate the evidence
to policy makers and program managers in a manner that is clear,
actionable and bridges the gap between research and policy. "Community
based newborn care by community health workers can reduce the neonatal
mortality by as much as 30%, provided the coverage is high, and
supervision is intensive" is a simple message, but often not
communicated clearly.
However, bridging the gap between evidence and policy
is easier said than done! Review of evidence on the use of evidence to
inform health care management and policy-making in Canada and the United
Kingdom provides some lead on how to bridge the gap. Policymakers reported
that they would benefit from information that is relevant to decisions
highlighted for them and having evidence contextualized to their settings.
They further reported that having reviews presented in a way that allows
for rapid scanning for relevance and then graded entry are more useful
than full reports. One of the ways graded entry can be achieved is through
the 1:3:25 principle i.e. 1 page of take home messages, 3 pages of
executive summary and 25 pages of report [6]. In another review, policy
makers in Australia reported difficulty in accessing useful research
syntheses as one of the major barriers in using research findings for
policymaking [7]. Equally important is the personal contact between
researchers and policymakers. This has been identified as one of the most
important facilitators of research use by policymakers, and absence of
such a contact becomes a major barrier [8].
This series of systematic reviews, a result of a
partnership between Public Health Foundation of India and UNICEF, is an
attempt to bridge the gap between evidence and policy for child health
programs in India. What is said in this series is often not new, but it
clearly provides synthesized evidence on the most effective interventions
for improving child survival, identifies critical barriers affecting the
scale up of these interventions and lists potential options. It is
essential to ensure that the synthesized evidence presented here for the
academic and scientific community is communicated in appropriate formats
and at appropriate forums to inform the policies and programs. We hope
that the exercise will kindle a culture of evidence based programs and
policies for improving child health in India, improving not only their
design but also their delivery. We invite the academicians and researchers
within the child health community to join in generating, synthesizing and
communicating relevant evidence for the same.
Competing interests: None stated.
Funding: None.
References
1. Anonymous. 150 years of cholera epidemiology. The
Lancet. 2005;366:957.
2. Anonymous. Miracle cure for an old scourge. An
interview with Dr Dilip Mahalanabis. Bull WHO. 2009; 87:2.
3. Coverage Evaluation Survey. National Fact Sheet. New
Delhi: UNICEF and Ministry of Health and Family Welfare, Govt of India;
2009.
4. Mathew JL, Patwari A, Gupta P, Shah D, Gera T, Gogia
S, et al. Acute respiratory infection and pneumonia in India: a
systematic review of literature for advocacy and action: UNICEF-PHFI
series on newborn and child health, India. Indian Pediatr.
2011;48:191-218.
5. World Health Organization 2000. Handbook of IMCI
(Integrated Management of Childhood Illnesses). Available from:http://202.54.104.236/
intranet/eip/immunization manager/pdf/CAH_00_12_Ti_Contents.pdf. Accessed
15 Feb 2011.
6. Lavis J, Davies H, Oxman A, Denis JL, Golden-Biddle
K, Ferlie E. Towards systematic reviews that inform health care
management and policy-making. Health Serv Res Policy. 2005;10:35-48.
7. Campbell DM, Redman S, Jorm L, Cooke M, Zwi AB,
Rychetnic L. Increasing the use of evidence in health policy: practice and
views of policy makers and researchers. Aust New Zealand Health Policy.
2009;6:21.
8. Innvaer S, Vist G, Trommald M, Oxman AD. Health policy-makers’
perceptions of their use of evidence: A systematic review. Health Serv Res
Policy. 2002;7:239-44.
|
|
|
|