Transcript Making health systems work for the poor

Embedded research and
development – design for RU
- for policy & practice change
HOW TO GUIDE ON
RESEARCH & DEVELOPMENT:
THE EMBEDDED APPROACH
Problems of getting research into practice
The usual research - dissemination model
1. Research “discovers” solutions, then try to
2. “Market” to busy decision-makers & practitioners
Is necessary, but not sufficient, as not:
1. start from needs of policy-makers & practitioners
2. a typical service context – so not replicable
3. Evidence products; guidelines, tools - for scale-up.
To change policy and practice, best embed research
within MoH programme - priorities, policies & sites
Embedded R and D – design for RU
- policy and practice change at scale
Intervention- trial &
qualitative & costing
studies
Evidence-based
intervention-package
design to be effective,
replicable & sustainable
Communications & RU - COMDIS H Service Delivery
Communication related activities include:
• Priority setting-coordination meetings, MoH
• Technical working group – eg draft guidelines
• Steering group, approval, decision to scale up
Research Uptake (RU)
• The policy and
practice change
- objectives outcomes
achieved
Evidence products (synthesise existing & new K):
• Clinical, operational, planning etc. guidelines
WHO level of evidence & strength of recommendation
• Training modules & tools – used in scale-up
• Policy briefs, case studies
• Peer-reviewed papers
• See the COMDIS Communications Handbook
Four stages of research & development:
with the policy-makers and users
• 1. Design and develop, evidence based review, and
if required explanatory research
• 2. Pre-test and pilot the intervention package
guidelines, modules, registers and other tools
• 3. Implement and trial the intervention/ package
• 4. Support policy and practice change (RU)
– go to scale in country, and X countries
Stages of Embedded R and D – leading to policy and practice change (RU)
STAGE 1
STAGE 3
Design and develop
service delivery package
in line with MoH
national priorities
Implement and
evaluate the
intervention
STAGE 2
Pre-test and pilot
package (e.g.
guidelines,
materials and
research tools)
STAGE 4 Support
both policy and
practice change
(RU) nationally and
internationally
Embedded R and D for CVD-diabetes in primary care
STAGE 1
Evidence-b review & generic
STAGE 3
clinical and life-style guides
& package developed
Implement
and evaluate
intervention
China, adapted in line MoH
rural insurance and public
health package policies
Similarly in Pakistan, Nigeria,
Tanzania & Swaziland
cluster RCT
STAGE 2
Pilot package
guidelines,
materials. Revision
of design of the trial
China
STAGE 4 Support
both policy and
practice change evidence products
- nationally and
internationally
NCDs – CVD-diabetes primary care
Design the service delivery
package within policies and
context - so likely replicable
and sustainable
ZHEJIANG PROVINCE CDC AND
UNIVERSITY
COMDIS CHINA AND LEEDS
China Cardiovascular
disease prevention
and control deskguide
Identify and manage cardiovascular
disease or risk
Draft 1 of 6.1.11
CVD risk - Diabetes
Drafted clinical & lifestyle guides
Pilot on-going
Cluster RCT to start April
Lunchtime IVI Antibiotics!
Antibiotic Misuse & drug
resistance Project