One year ago I attended the First Global Symposium on Health Systems Research in Montreux, Switzerland, as an Emerging Voice. I was amazed by the posters that were talking about many problems, and the ways to solve them. I am from Bangladesh and although most posters were not from Bangladesh, the problems seemed surprisingly similar to ours. The same issues related to retaining human resources for health in rural areas, achieving universal health coverage through the most suitable mechanism, tackling child and maternal mortality, integrating NCDs in PHC delivery, achieving equity in health service provision, establishing meaningful health information systems, pay for performance, and many more.
I felt happy and frustrated at the same time. On the one hand, I was glad that I had been selected as an Emerging Voice and could share my thoughts with the most important public health figures in the world (with whom I never even imagined of talking face to face in the first place). I also enjoyed my stay in posh hotels in Antwerp and Montreux, and had a great time sharing a bunch of ‘provocative’ ideas with a number of vibrant young public health enthusiasts from all over the globe, and traveling through picturesque European landscapes. But at the same time, deep down I felt strangely frustrated and powerless as I did not know how my thoughts, eagerness, and ideas could solve some of the public health problems in my own country.
As I was walking through the poster presentation area of the Montreux Music and Convention Center, a reporter from WHO came up to me and asked what my reflections/thoughts were on the conference. Obsessed with my desire to channel my research findings and thoughts, I reflected on the knowledge translation issues – issues that had been discussed in some of the sessions on knowledge translation, issues that I conveyed during some of the sessions, issues that were bubbling up in my baffled mind. I would like to share some of the concerns that tormented me a year ago, as they continue to haunt me.
In a country like Bangladesh, where the literacy rate is only 56%, the importance of knowledge translation never gets its due consideration. Evidence based policy, as far as Bangladesh is concerned, is something that reads well only in books on most occasions. In my humble opinion, policymakers don’t refer to scientific journals as much as they would be expected to do in making informed policy decisions. The Ministry of Health and its organs are largely run by clinicians, many of whom don’t have extensive training in public health. Unfortunately, too many Decisions are taken on political consideration only. Eventually when the government is changed, even the successful programs along with their personnel (who were hired by the previous government, and hence believed to be supporters of that party) are gotten rid of, despite evidence of success. One such example is the revoking of a promising Community Clinic program by the new government, as it happened to be established by the former government. But this is by no means the only example.
In summary, in many developing countries, it is not the lack of research, but the lack of a culture of evidence based policy making that hinders the process of deriving effective policies. Far too many policy makers fail to realize the importance of evidence based policy making, however strange it may sound to the readers of the developed world. Policies are not given the due considerations needed and even changed due to mere change in the political government, as exemplified above. Too many prospective policies are not critically scrutinized enough in order to establish their merit in a resource limited setting. In our political environment, it is all too common for the new government to wipe out most if not all policy oriented gains made by the former. Even the formal mechanism to commission evaluation research is lacking.
Therefore, it is imperative that the personnel of MoH and the actions taken by them be independent of the political process and its periodic shifts. Additionally, I strongly believe that WHO or any other related organization should bring this issue to the table of discussion and urge the governments/policy makers to establish a system of meeting the academia/researchers on a regular basis. Policy makers should develop the habit of seeking feedback from the experts before taking decisions on important health issues, e.g. introducing demand side financing programs, starting user fees in PHC centers, introducing some type of health insurance system, providing incentives to the Human Resources for Health in order to serve in rural areas, etc. The MoH should be strongly encouraged to facilitate knowledge translation from the local academia/researchers and be held accountable for doing so. Demands should be created in international meetings, symposiums, conferences in order to put knowledge generation, knowledge translation, and evidence based policy making at the forefront of the policy making process, in every country.
So why not start these discussions at the upcoming ‘Prince Mahidol Award Conference 2012: Moving towards Universal Health Coverage: Health Financing Matters’?