Equity and diversity in HP capacity development

[nastaran.keshavarz]

Nineteen years ago, “the 10/90 gap” was coined to convey the striking inequity in health research between developed and developing countries as a result of findings of the Commission on Health Research for Development published in a landmark report, Health Research—Essential Link to Equity. Since, for those concerned with equity, capacity development for health research has been widely recognised as key strategy to fill this gap.

Filling this equity gap not only is justified (should be justified) from an equity perspectives, we can also consider it from a diversity perspective. Low representation of data and perspectives from less developed countries /communities reduce the comprehensiveness of our understanding of the complex health challenges we as global health promotion community face in the 21 century. This low diversity in our understanding of health problems and hence solutions, also may lead to a widening gap between research and practice in different contexts.

We would like to develop further discussions and debates regarding capacity development around these questions:

• What do we mean by capacity for health research?
• How unequal is access to capacity development opportunities? What are the causes?
• What capacities need to be developed for less developed countries?
• How can we develop the required capacities for health researchers from less developed countries?

Within the IUHPE, the ISECN has formed several working groups. One working group is concerned with equity and diversity in health promotion practice. Building upon the ideas emerging from our discussion in this working group; we hope that this stream can stimulate dialogue and discussion on this important issue.

Further reading:
1.The weblog for Equity and diversity working group:
http://hpequitydiversity.blogspot.com
2.Commission on Health Research for Development. Health research: essential link to equity in development. New York: Oxford University Press; 1990.
3.Evans JR. Essential national health research: a key to equity in development. N Engl J Med 1990;323:913-5.
4.Michaud C, de Francisco A, Young A. Global resource flows into health research in 1998 and trends during the nineties: first results [lecture]. (Paper II, Resource flows project.) International Conference on Health Research for Development; 2000 Oct 10-13; Bangkok (Thailand).
5.World Health Organization. The world health report 1999: making a difference. Geneva: The Organization; 1999.
6.Suwanwela C, Neufeld V. Health research for development: realities and challenges. In: Neufeld V, Johnson N, editors. Forging links for health research: perspectives from the Council on Health Research for Development. Ottawa: International Development Research Centre; 2001. p. 245-8.

[vincentobrien]

One way to help develop research capacity in developing countries is to establish links between researchers and to encourage collaborations that are not dependent on large scale funding. Ethnographic studies are particularly suitable since they proved an opportunity for community based staff to gather data during the normal course of their work. Start up and follow up field trips can be supported by online collaborations throughout the project and as research capacity develops (for both parties) the outputs start to gain attention.

Here's an example from my own experience.

In 2002 I was coordinator for a curriculum development project working in partnership with the Kyrgyz State Medical Academy in Bishkek. When the project finished there was no funding available to continue our partnership but the health promotion oriented Public Health Courses we had developed were still in their infancy and there were few resources available to support learning and teaching. I had been using video and photography in my own teaching to help students develop their understanding of narrative structure for essay writing and it occurred to me that it was also good way for the the kyrgyz students to record, explore and discuss the social and cultural context of health in kyrgyzstan. I found some money and we were able to send a video camera and Apple laptop to Bishkek.

Later on we decided to test out our participatory visual narrative ideas with people living in remote village communities, with great success. The whole project - Visible Voice, http://www.visiblevoice.info has continued to develop and the technique is proving to be a very effective research method that is also an excellent community development tool.

We now have Visible Voice projects in Brazil, Kyrgyzstan and with refugee and migrant communities in the UK. They are all very much ' shoestring' projects, but the outputs have been significant both as research outputs but also as community engagement activities. You can view films and images from the projects and read some of publications listed below in the resources area of the on the Visible Voice website.

Vincent O'Brien
University of Cumbria



Further Reading

O'Brien, V., Djusipov, K. & Kudaibergonova, T. (2005) Public health challenges in Kyrgyzstan: developing a new curriculum. Rural and Remote Health, 5, 461.

O'Brien, V., Djusipov, K. & Wittlin, F. (2007) Visible voices, shared worlds: using digital video and photography in pursuit of a better life. Proc Mundane Technologies and Social Interaction ACM SIG,

O'Brien, V., Djusipov, K. & Wittlin, F. (2007) Visible voices, shared worlds: using digital video & photography in pursuit of a better life. Proc. Workshop on Mundane Technologies,

O'Brien, V., Djusipov, K. & Esengulova, N. (2008) Embracing the Everyday: Reflections on using video and photography in health research. Social Interaction and Mundane Technologies (SIMTECH) 08,

[nastaran.keshavarz]

Dear Vincent,
Thanks for sharing your ideas and experiences. I agree that modern technology has created new opportunities for capacity development among health researchers in developing countries. However, sometimes it is not easy to utilize these new opportunities to share local experiences due to short term availability of financial assistance as well as the technicality of the issue.
Hence, it is easier to know about the research undertaken in developed world orby researchers fromthose countries (as they are easily available online) than to find research conducted within the country even in close geographical distance.

This may suggest that we need to view the capacity for health research wider than the research methodologies .Perhaps communication technologies and skills can be defined as one of the required capacity for research in less developed countries. What do you think?
Best
Nastaran

[Isabelle.Goupil]

Hello,

First, I would like to apologize...

A sounded reply for this forum should at least be supported by literature or at least a bit documented (like my predecessor did). Sorry.

But in fact, I'm not sure to be able to respond to any of the questions addressed :
- Capacity development should be neutral in its formulation. It should not imply that an "incapacity" has been diagnosed... but that a specific capacity could be improved. Capacity development should also consider what is already there.
- The kind of research needed and how come should it be done in a cultural sensitive context has to be addressed. Even the term research is not neutral in my point of view.
- For whom and by who should the research be done are some other key concepts.
- Lay capacity and participatory research are also key to the concept of capacity development.
- Local research has first to be done for local community and capacity development in HP is all related to how improve health... research is just one way to improve it. We need to know what matters, how it matters, why it matters and how come it is related to health. Then solution should be provided... research is one set of methodologies to get to it.

My very small experience in health promotion in Africa taught me that research done in a western manner for publication in official scientific peer reviewed journals is not a very efficient way to address issues and to improve health of community we act in.

HP is all about methods to improve health, in a positive way. Research is not a neutral term... it implies that we need to explore, critics, analyse a situation... but some times, research is not what we need... and capacity development is more related to access to education, minimum wage or women empowerment.

Isabelle Goupil-Sormany
Laval University

[tripstory]

The post by this person was deleted by the stream manager as it appears to have no meaning or relation to the topic.

[nastaran.keshavarz]

Hi
I like what Isabelle wrote in her post as :

"My very small experience in health promotion in Africa taught me that research done in a western manner for publication in official scientific peer reviewed journals is not a very efficient way to address issues and to improve health of community we act in."

Our experience in Asia (Middle East) is similar. However, unfortunately it appears that health researcher's concern sometimes shifts from "solving a real and local health problem" to "publishing a paper in prestigious journals !"
I think we need to acknowledge more that we really need to keep"think global but act local".

I believe a capacity that needs to be developed particularly in developing countries is " confidence" . They need to feel confident to think different or act different (if needed) and beive in their individual and collective competencies while they also get help from external resources and knowledge.
What do you think?

Best

[Torill.Bull]

Dear Nastaran and all who have contributed to this discussion so far,

I feel a bit helpless as I start writing this. This topic is SO wide, and SO challenging. It is about the way we have organized the whole global society - and still we need to come down to practicalities to improve equity. And as the problem is so complex, the solutions may be so different - and hopefully complementing each other.

I like the ideas that have been introduced in this dialogue - I like the highly practical approach by Vincent O'Brian, for instance. That approach has proved to be transferrable, and low cost, and with an effect for those engaged. I also like the points made about ownership of projects and research, participatory approaches, etc. And the issue of the 'divide' in publishing/literature/journals is of huge importance, with large parts of the world being simply shut out due to language, technology, lack of networks, etc.
Also, the way conferences are organized today really troubles me. Not only are too many conferences located for easy access from the Western world, but more seriously still, I think, the registration fees are outrageous. Why do we make conferences too expensive? Why do we KEEP making them too expensive? Why do we chose so elegant venues, so expensive performances at opening ceremonies, so fancy social events? Why don't we keep prices low and channel resources into bursaries?! Also, locating conferences in Western countries leads to high costs for accomodation and meals for travelling participants. I think this is a real obstacle to equal access to capacity building.
Also, I think education is key to capacity building - both local education and opportunities for education abroad. In the latter case, one has to take measures to guard against 'brain drain'. At the University where I work there is an international master's programme/PhD programme where students from developing countries are funded by a national organisation in my country, on the condition that students return to their home countries to contribute to development there after the completion of their education. If students do not return, the economic support received is turned into a loan which have to be paid back. This is one way of contributing to capacity building, and one that could be established in other countries, with some effort and goodwill.
Even better, of course, is developing educational programmes within developing countries, on terms to a greater extent decided by the developing countries themselves. The NUFU project is a project of that kind, helping large numbers of students in sub-Saharan Africa achieve Master's and PhD degrees.
I guess my point is that there are so many ways to go, and that all measures seems to be necessary... (and, finally, I would beg that we do not disrespect all research on health in developing countries that is done by researchers from developed countries. It is not that research that needs to be stifled, but the other research that needs to be stimulated, isn't it?)

Torill Bull

[nastaran.keshavarz]

Dear Torill and all,
Thanks for your interesting post. You opened a new aspect to the discussion and that is the role of developed countries in contributing to promoting equity and diversity in health promotion capacity development.
Funding for capacity development opportunities by developed country, like the one Burgen University does for postgraduate studies, is one of the best strategies proving to be effective. You objected the high expenses of conference registration and their location. I agree with you. Two years ago I attended Geneva Health Forum. It was unique in terms of number of people from developing countries who attended . why? Because there were several financial supports available for those from developing countries such as free or reduced registration fee. But surprisingly, there was free accommodation available as well especially for students attending the conference. Many generous Swiss people living in or close to Geneva, majority member of conference organizing committees hosted them. Regardless of financial aspect of this initiative, it also provides a good opportunity for cultural closeness between people.
Another strategy may be establishing policies that demand for considering equity and diversity in distributing capacity developments for people in terms of both, gender and their nationality. I know that WHO implement such strategy for employment as well as holding its technical or consultation meetings. .
I believe if there is such strategy in forming editorial boards, steering committees and working groups, advisory groups and etc in all international journals, organizations networks and conferences, perhaps with some additional financial or technical support from people form less represented nations/regions, we all can benefit from better equity that also promotes diversity and richness of contributions. I would like to know what others think about this strategy, having “ an equity and diversity policy or an index”? Can we consider it as an ethical point as well?

Looking forward hearing from you
Nastaran
(Global chair for Equity y and diversity, ISECN)

[Torill.Bull]

I think we can definitely consider such a point as an ethical point, for me it is at the core of ethical thinking. Many national states and institutions have policies of equity and diversity in filling positions etc, and I think it is a good idea to investigate how this could be applied in the different contexts where we operate, and especially in HP contexts.

Also: I will immediately suggest that the IUHPE conference in Geneva in July 2010 take up the idea of providing low-cost or even free boarding in private homes for participants from developing countries. Also, all efforts possible should be made to reduce registration fees for students from developing countries.

[j.hope.corbin]

Dear Nastaran, Torill, et. al,

I think this is such an important discussion.

I grew up in a country (USA) that has such an equity policy in many of its government employment agencies and also in its universities. It is referred to as "Affirmative Action" (see: http://plato.stanford.edu/entries/affirmative-action/). The purpose is to provide more opportunities for both ethnic minorities and also to women. Although the policies have been met by much controversy-- I personally believe that it has greatly increased the ability of people who had been previsouly excluded to pursue new goals and dreams.

I understand there are real obstacles in the way of achieving equitable capacity building to health promoters in many countries and also to professionals in certain areas within countries. I think one way to begin overcoming these challenges may lie in the new possibilities available for organizing and networking with other professionals at very little cost. I understand that not everyone has access to internet, but more and more are becoming connected-- and many opportunities exist through these more equitable modes of communication.

I can give the example of the IUHPE's Early and Student Career Network (ISECN). ISECN has never had a dime of funding, yet we are currently engaged a number of projects that are linking Northern and Southern researchers in research projects that (we trust) will be accepted for publication and presentation in scholarly journals and conferences. These activities may help to bridge some of the gaps of inequity by linking early professionals in different geographic areas with different, knowledge and skills to work together, voluntarily, on topics of shared relevance.

It is not a complete answer by any means-- but I do think that technology is evolving in such a way that, perhaps, as we are waiting for the rest of the world to change-- we can be working around the dominant structures which have so far been so biased and inequitable.