Browsing by Person "Pokhrel, Subhash"

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Applied social sciences for public health (‎ASSPH)‎ : higher degree training for implementation research on tropical diseases
(World Health Organization, 2007) Gouda, Hebe; Fox-Rushby, Julia; Heald, Suzette; Helman, Cecil; Parker, Melissa; Pokhrel, Subhash; Skelly, Chris; Reidpath, Daniel; Allotey, Pascale
Understanding and monitoring the dynamic nature of a population’s health is critical for successful health promotion, disease prevention and disease control. It necessarily involves a multidisciplinary and interdisciplinary endeavour. Many of the research techniques and tools to facilitate this are available across the range of social sciences. However, as a result of economic and other factors, building and retaining of research capacity in applied social sciences for public health (ASSPH) in resource-poor countries has been a challenge. There is therefore a serious lack of ASSPH researchers and consequently an ongoing dearth in high quality research that involves social, economic and behavioural aspects of tropical disease control despite the clear need for evidence in this area. This need was identified in the TDR review of research capacity strengthening in 1999 (TDR, 2000). However, seven years later, the problem remains critical. A further need has been identified for applied social science research in the process of implementation of disease control programmes – i.e. for ‘implementation research’. Over the last 30 years, TDR and other medical research institutions have invested substantial funds in the development of interventions for the management of tropical diseases. However, in the absence of capacity and understanding in how to engage with communities and ensure their participation, and of the ability to adapt research methods and health technologies to local contexts, the uptake, effectiveness and sustainability of these interventions remains limited. The lack of high quality social science research expertise to combine an understanding of tropical diseases with the ability to work with and understand the local community is chronic. Further expertise is also required to integrate this knowledge with institutional and organizational structures that support the successful and sustained uptake of new technologies. This present initiative draws on existing capacity in sub-Saharan Africa (SSA) with support from Southern and Northern partners to develop high quality, internationally recognized, higher degree interdisciplinary and multidisciplinary research training that is grounded in theoretical and applied social science and public health disciplines and relevant to local contexts. These programmes will be offered through regional centres of excellence. As background to the initiative, this report is a compilation of three independent but inter-related documents presenting background information on ASSPH and a strategy for building capacity in subSaharan Africa. The specific focus is on training a workforce for implementation research at Master’s and potentially PhD level. The report presents: • A background on the training needs in ASSPH in sub-Saharan Africa and an overview of related courses and programmes available locally and internationally. • A strategic vision for capacity building in ASSPH based on consultations with stakeholders in the region and in related disciplines. • A review of current training capacity and proposed training programmes in Ghana and Kenya for Anglophone countries in West and East Africa respectively.
Behaviour Change in Public Health: Evidence and Implications
(BMC, 2015-08-25) Pokhrel, Subhash; Anokye, Nana K.; Reidpath, Daniel; Allotey, Pascale
The fallacy of the equity-efficiency trade off: rethinking the efficient health system
(BMC, 2012-06-22) Reidpath, Daniel; Olafsdottir, Anna Elisabet; Pokhrel, Subhash; Allotey, Pascale
In the health systems literature one can see discussions about the trade off between the equity achievable by the system and its efficiency. Essentially it is argued that as greater health equity is achieved, so the level of efficiency will diminish. This argument is borrowed from economics literature on market efficiency. In the application of the economic argument to health, however, serious errors have been made, because it is quite reasonable to talk of both health equity being a desirable output of a health system, and the efficient production of that output. In this article we discuss notions of efficiency, and the equity-efficiency trade off, before considering the implications of this for health systems.
Health systems performance in sub-Saharan Africa: governance, outcome and equity
(BMC, 2011-04-16) Olafsdottir, Anna E; Reidpath, Daniel; Pokhrel, Subhash; Allotey, Pascale
Background The literature on health systems focuses largely on the performance of healthcare systems operationalised around indicators such as hospital beds, maternity care and immunisation coverage. A broader definition of health systems however, needs to include the wider determinants of health including, possibly, governance and its relationship to health and health equity. The aim of this study was to examine the relationship between health systems outcomes and equity, and governance as a part of a process to extend the range of indicators used to assess health systems performance. Methods Using cross sectional data from 46 countries in the African region of the World Health Organization, an ecological analysis was conducted to examine the relationship between governance and health systems performance. The data were analysed using multiple linear regression and a standard progressive modelling procedure. The under-five mortality rate (U5MR) was used as the health outcome measure and the ratio of U5MR in the wealthiest and poorest quintiles was used as the measure of health equity. Governance was measured using two contextually relevant indices developed by the Mo Ibrahim Foundation. Results Governance was strongly associated with U5MR and moderately associated with the U5MR quintile ratio. After controlling for possible confounding by healthcare, finance, education, and water and sanitation, governance remained significantly associated with U5MR. Governance was not, however, significantly associated with equity in U5MR outcomes. Conclusion This study suggests that the quality of governance may be an important structural determinant of health systems performance, and could be an indicator to be monitored. The association suggests there might be a causal relationship. However, the cross-sectional design, the level of missing data, and the small sample size, forces tentative conclusions. Further research will be needed to assess the causal relationship, and its generalizability beyond U5MR as a health outcome measure, as well as the geographical generalizability of the results.
Social sciences research in neglected tropical diseases 2: A bibliographic analysis
(BMC, 2011-01-06) Reidpath, Daniel; Allotey, Pascale; Pokhrel, Subhash
Background There are strong arguments for social science and interdisciplinary research in the neglected tropical diseases. These diseases represent a rich and dynamic interplay between vector, host, and pathogen which occurs within social, physical and biological contexts. The overwhelming sense, however, is that neglected tropical diseases research is a biomedical endeavour largely excluding the social sciences. The purpose of this review is to provide a baseline for discussing the quantum and nature of the science that is being conducted, and the extent to which the social sciences are a part of that. Methods A bibliographic analysis was conducted of neglected tropical diseases related research papers published over the past 10 years in biomedical and social sciences. The analysis had textual and bibliometric facets, and focussed on chikungunya, dengue, visceral leishmaniasis, and onchocerciasis. Results There is substantial variation in the number of publications associated with each disease. The proportion of the research that is social science based appears remarkably consistent (<4%). A textual analysis, however, reveals a degree of misclassification by the abstracting service where a surprising proportion of the "social sciences" research was pure clinical research. Much of the social sciences research also tends to be "hand maiden" research focused on the implementation of biomedical solutions. Conclusion There is little evidence that scientists pay any attention to the complex social, cultural, biological, and environmental dynamic involved in human pathogenesis. There is little investigator driven social science and a poor presence of interdisciplinary science. The research needs more sophisticated funders and priority setters who are not beguiled by uncritical biomedical promises.
Social sciences research in neglected tropical diseases 3: Investment in social science research in neglected diseases of poverty: a case study of Bill and Melinda Gates Foundation
(BMC, 2011-01-06) Pokhrel, Subhash; Reidpath, Daniel; Allotey, Pascale
Background The level of funding provides a good proxy for the level of commitment or prioritisation given to a particular issue. While the need for research relevant to social, economic, cultural and behavioural aspects of neglected tropical diseases (NTD) control has been acknowledged, there is limited data on the level of funding that supports NTD social science research. Method A case study was carried out in which the spending of a major independent funder, the Bill and Melinda Gates Foundation (BMGF) - was analysed. A total of 67 projects funded between October 1998 and November 2008 were identified from the BMGF database. With the help of keywords within the titles of 67 grantees, they were categorised as social science or non-social science research based on available definition of social science. A descriptive analysis was conducted. Results Of 67 projects analysed, 26 projects (39%) were social science related while 41 projects (61%) were basic science or other translational research including drug development. A total of US$ 697 million was spent to fund the projects, of which 35% ((US$ 241 million) went to social science research. Although the level of funding for social science research has generally been lower than that for non-social science research over 10 year period, social science research attracted more funding in 2004 and 2008. Conclusion The evidence presented in this case study indicates that funding on NTD social science research compared to basic and translational research is not as low as it is perceived to be. However, as there is the acute need for improved delivery and utilisation of current NTD drugs/technologies, informed by research from social science approaches, funding priorities need to reflect the need to invest significantly more in NTD social science research.