PHA-Exch> A Call for Expressions of Interest to Participate in New Research and Research Training in Comprehensive Primary Health Care

[Claudio Schuftan]

*

PHM

Revitalizing Health for All:

A Call for Expressions of Interest to Participate in New Research and
Research Training in Comprehensive Primary Health Care
*

Background

In 2007, an international network of researchers and people involved in
building comprehensive primary health care (CPHC) received funding to
support research and research capacity-building. This network, associated
with the People's Health Movement, includes individuals in India, Africa,
Latin America, Europe, Canada and Australia.

By comprehensive primary health care, we mean an approach to health systems
organization and services that tries to achieve the following:

a. increased equity in access to health care and other services/resources
essential to health

b. reduced vulnerabilities through changes in community empowerment
(capacities)

c. reduced exposures to risk through changes in social and environmental
determinants of health

d. improved participatory mechanisms and opportunities and political
capabilities of marginalized population groups reached by comprehensive
primary health care initiatives

e. increased community resilience to enable effective responses to promote
and protect health

f. equitable increase in population health outcomes

The ideals of comprehensive primary health care were first launched
internationally by the 1978 Alma-Ata Declaration on Primary Health Care.
This Declaration was partly based on earlier primary health care successes
in significantly lowering infant, childhood and maternal mortality rates and
creating over all population health improvements in many parts of the
developing world.

Since the Alma-Ata Declaration, however, most health systems reform in much
of the world has been driven by 'selective' (single-disease or intervention
focused) primary health care, and by increased marketization of health care
services (e.g. user fees, privatization). This has led to increasingly
complex, inefficient and inequitable health systems driven by an ever larger
number of special 'global health initiatives.' Resulting problems of
sustainability in selective primary health care programs, and the weakening
of public health systems and their capacities to work intersectorally on the
determinants of health and with communities in more authentic forms of
partnership, has led to calls for the renewal of comprehensive primary
health care by the World Health Organization, the Pan-American Health
Organization, and health ministries and civil society groups around the
world.

Our Project

With funding support from the Canadian Global Health Research Initiative and
its 'Teasdale-Corti' Research Program, our project goals are to:

a. systematically review recent past experiences of comprehensive primary
health care from different regions of the world to determine what we know
about how it works, what it needs to work and what it has accomplished

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b. train up to 20 early career primary health care researchers in
undertaking new or augmenting existing CPHC research studies, in teams with
'research users' (health policy or program planners) and research mentors
(experienced CPHC researchers)

c. provide financial support to these research teams to undertake their
proposed studies

d. support the building of regional networks of researchers and research
users (including civil society groups) to advance comprehensive primary
health care as the basis for health system reform in their own countries

e. create a rigorously sound knowledge base on the role of comprehensive
primary health care in improving health equity that can be used in the
advocacy work of these regional networks

f. strengthen the People's Health Movement in being a global voice for
comprehensive primary health care

Call for Expressions of Interest

Our project is now seeking applications ('Expressions of Interest') from
research teams committed to developing important new knowledge and action on
comprehensive primary health care. These research teams will come from one
of four different areas/regions in which are focusing our overall project
work:

Region 1: India and South Asia

Region 2: Africa

Region 3: Latin America

Region 4: Indigenous/Aboriginal peoples in Canada and Australia

Who?

Each team will be made up of:

• an early career researcher (someone who is just beginning to study primary
health care)

• a 'research user' (someone who is working in health systems developing or
implementing primary health care policies or programs, and who is in a
sufficiently senior position to make or influence decisions based on new
research knowledge)

• a mentor (a more senior researcher with experience in research on CPHC,
health systems, health and development or other related social development
area)

Research teams could come from universities, governments, non-governmental
organizations or any other group that is involved in primary health care. At
least one of the team members must work in an organization legally eligible
to receive research grant funding.

Anyone needing assistance in creating a team (e.g. locating one or more
potential team members) should contact the Research Coordinator, Dr. Corinne
Packer (*cpacker at uottawa.ca*).

What will participation in the project entail?

Each team will prepare a first draft of an Expression of Interest
(essentially an outline of a research proposal) that will address an
important question, or set of questions, about comprehensive primary health
care. (See Writing your Expression of Interest). The proposals will be
reviewed by members of our project coordinating group.

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Up to 6 of these proposals from each of our four regions will be funded to
attend a 2 week training program in 2008 on researching comprehensive
primary health care. Research users will be encouraged to attend for the
full 2 weeks, but where this is not possible it is essential that they
attend the first week. During this 2 week training program, research teams
will have an opportunity to develop their proposals in greater detail. Teams
supported directly through this initiative will also be provided with some
financial support to conduct their research. Teams not selected for this
support may be invited to participate in the training program and subsequent
regional meetings on a cost-recovery basis. Due to limited funding available
through this initiative, all invited teams (whether funded by the initiative
or participating on a cost-recovery basis) will be asked to indicate in
their Expression of Interest what other sources of funding they already
have, or may be able to access.

All teams who attended the first year training program will also be expected
to attend a 3 day follow-up training programs in 2009, which will be
accompanied by a 1 day regional meeting on CPHC. They will also be expected
to attend a second regional meeting in 2010.

There will be four separate sets of training programs, one for each of the
four regions.

Timeline:

31 March 2008: Deadline for Expressions of Interest

September – November 2008: Two week training program (see 'Proposed Venues
and Dates for Regional Training Programs' at end of this Call for
Expressions of Interest)

October 2008 – November 2010: New funded research studies

September – November 2009: First regional meeting and 3 day Training Program


September – November 2010: Second regional meeting

Sometime in 2011: A global meeting on overall project results (to be
determined, based on obtaining new funding)

Writing Your Expression of Interest

The Expression of Interest should be no more than 5 pages long. It should be
developed collaboratively between both team members (the researcher, and the
research user). It must contain the following information:

a. An introduction explaining how the research questions/proposal fits with
our project's overall research questions; with the local, national or
regional context of CPHC; and with the regional research priorities
identified in our literature review. (See below for our list of overall
research questions and regional research priorities.) The introduction
should also contain a brief statement of any previous work the team members
may have done together, i.e., their prior collaborative experience. Length:
about ½ page.

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b. A section on your research questions, design (e.g. natural experiment,
quasi-experimental, comparative case study, historical/longitudinal),
methods (participatory action research and mixed methods approaches
recommended); and how the design and methods will allow generation of
policy/program relevant evidence of both implementation (process) and
outcome (impact). Applicants should also indicate here whether their
research will involve the participation of human beings and will thus
require ethical review. Length: about 1½ pages.

c. A section where you describe why your research is new or, if a
continuation of already studied comprehensive primary health care, how it is
asking a new set of questions that will generate new knowledge. Length:
about ½ page.

d. A section where you discuss what community involvement, including
involvement of People's Health Movement, occurred that led to the selection
of your research questions and methods. Length: about ½ page.

e. A section where you discuss your team's past or current engagement with
larger networks of primary health care researchers, research users and
citizen groups; and the ideas you have for how your team and your proposed
research project could strengthen such networks. Length: about ½ page.

f. A section where you identify some initial ideas of how you would engage
with practitioners, policy workers and community groups for uptake of your
research findings. Also estimate the amount of time each team member will
commit to the research. Length: about ½ page.

g. A preliminary budget for your study indicating the categories of
expenditure (e.g. researcher salary, research assistance, equipment, travel,
etc.). Indicate here if you require funding directly from our project for
this research (see Table below for regional-adjusted maximums that can be
funded directly by our project), and/or if you have access to other funding
opportunities (including in-kind contributions) to support it. Length: about
½ page.

We expect that changes to the research proposed in the EOI may occur as a
result of participation in the training program.

Table 1: Regionally-adjusted Maximum Stipends

Region 1: India and South Asia

Up to 5 applications will be accepted. Each will be granted a stipend of a
maximum

CAD 17,200 for the length of the project (per team)

Region 2: Africa

Up to 5 applications will be accepted. Each will be granted a stipend of a
maximum

CAD 24,200 for the length of the project (per team)

Region 3: Latin America

Up to 5 applications will be accepted. Each will be granted a stipend of a
maximum

CAD 24,200 for the length of the project (per team)

Region 4: Indigenous/Aboriginal peoples in Canada and Australia

Up to 6 applications will be accepted. Each will be granted a stipend of a
maximum

CAD 27,300 to cover the length of the project (per team)

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Additional Application Documents

Each Expression of Interest must be accompanied by the following
documentation:

a. A signed statement from each team member committing themselves to
participate in all three training programs, should they be selected.

b. A signed letter from the university or employer of each team member
committing to providing the time for the team members to attend to training
programs (all costs for attendance will be covered by our project), to
undertake the research (if funded directly by our project) or to further
develop their proposal.

c. A letter from a mentor (senior researcher) indicating willingness to
support the research team as needed over the three years of the training
programs and research study.

d. A list of any other collaborators the team has involved in its Expression
of Interest.

e. CVs (resumés) of each team member. These can be whatever standard
university or professional CV they presently have, but it must contain at a
minimum the following:

o Their academic and/or professional backgrounds

o Their prior work in/knowledge of comprehensive primary health care

o Their prior work in any research or implementation/policy projects
relevant to comprehensive primary health care

o Publications, policy papers, articles or other major
presentations/disseminations on the topic of comprehensive primary health
care

o Extent of involvement in social movements related to health

How We Will Review Your Expressions of Interest

We have established regional review teams drawing from our project's
coordinating group. Each Expression of Interest will be reviewed in depth by
at least two different people, who will prepare written assessments. These
assessments and each Expression of Interest will be discussed amongst the
larger review team.

The criteria used in these assessments will include:

• Clarity of the proposal's relationship to project's overall and regional
research questions and goals

• Extent to which research questions are contextualized in national,
regional or local CPHC histories and issues.

• Clarity of the research questions, design, methods and the rationale for
them

• Confidence in the team's abilities to undertake the research (based on
their CVs and prior training or experience in primary health care, support
from a senior mentor, prior working relationship, involvement with a larger
network)

• Evidence of community involvement in setting the research questions

• Strategies for research dissemination

• Degree to which knowledge generated by proposal will usefully inform
practitioners, policy makers, community groups or activists in People's
Health Movement or other social movements

• Written support for their participation from their university/employer

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How to Send Your Expression of Interest

Applications may be submitted in either English or Spanish. Only one
application per person is allowed.

Expressions of Interest should be sent electronically (e-mailed), with all
of the additional required documents, to:

Corinne Packer (cpacker at uottawa.ca)

no later than: March 31st, 2008. Late applications will not be accepted.

One hard copy of the full application (Expression of Interest and additional
required documents) should also be posted, postmarked by midnight March
31st, 2008, and mailed to:

Corinne Packer

Room 214

Institute of Population Health

University of Ottawa

1 Stewart Street

Ottawa, Ontario

Canada

K1N 6N5

Receipt of your Expression of Interest will be promptly acknowledged.

For further population- or region-specific information, please contact the
individual listed below according to your interest.

Region 1: India and South Asia

Dr. Thelma Narayan: thelma at sochara.org

Region 2: Africa

Ms. Nikki Schaay: schaay at mweb.co.za

Region 3: Latin America

Prof. Eduardo Espinoza: eduardo at espinoza.ca

Region 4: Indigenous/Aboriginal peoples in Canada and Australia

Dr.. Raven Sinclair (Canada): raven.sinclair at uregina.ca

Dr. John Boffa (Australia): john.boffa at caac.org.au

Project's Overall Research Questions

Your Expression of Interest should reflect how it will help to answer one or
some of the overarching research questions that guide our project. These
are:

1. What is the evidence of the effectiveness of comprehensive primary health
care on:

a. increased equity in access to health care and other services/resources
essential to health

b. reduced vulnerabilities through changes in community empowerment
(capacities)

c. reduced exposures to risk through changes in social and environmental
determinants of health

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d. improved participatory mechanisms and opportunities and political
capabilities of marginalized population groups reached by comprehensive
primary health care initiatives

e. increased community resilience to enable effective responses to promote
and protect health

f. equitable increase in population health outcomes

2. What new knowledge do we need on:

a. Strategies or mechanisms used by CPHC in different contexts that work
best to achieve the outcomes specified above.

b. How the development level and political and policy context of countries,
or within-country inequities in wealth and/or regional differences in
policy, affect these impacts.

c. What combinations of resources, policy and state/civil society/university
relationships facilitate and sustain appropriate and effective comprehensive
primary health care.

d. What types of strategies or forms of mobilisation have secured the above
resource and organisational arrangements.

e. What are the enabling and constraining international conditions for
establishing sustainable comprehensive primary health care systems,
including a consideration of how the macro economic and health sector reform
policies, concepts and methods of the industrialized countries and
international financial institutions have influenced these international
conditions.

f. What research skills and methodological approaches are necessary to
underpin the effective operation of CPHC and the production of a convincing
evidence base.

g. What is the role of locally conducted research projects in contributing
to development of local CPHC systems and to the international evidence base
on CPHC.

3. What approaches to research, and what research/evaluation tools and
methods, are most useful in advancing understanding of, and action on, CPHC
implementation?

a. What program evaluation methods are most suited for use in a CPHC
setting?

b. How can the effectiveness of community empowerment in CPHC be measured?

c. What research and implementation knowledge, skills and values may be
required for the advocacy component of CPHC in particular contexts?

d. To what extent do existing methods of quality assurance designed for
community health settings capture the effectiveness of CPHC?

e. How can health information systems be modified to take greater account of
local and culturally-specific health frameworks and indicators, particularly
for Indigenous groups?

f. What is the cost-effectiveness of CPHC in particular settings?

g. To what extent do the health care reform processes being implemented in
particular settings support the implementation of CPHC?

h. What indicators can be used to measure the extent to which a health
system has re-orientated towards CPHC?

Other General Questions Identified from the Literature Review

Policy

1. How have neoliberal economic and social policies affected CPHC?

2. How are policy-decisions made regarding comprehensive vs. selective
primary health care?

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3. How do government or donor contractual requirements for NGOs delivering
PHC affect the comprehensiveness of their PHC services?

4. How have global health initiatives affected implementation of CPHC?

5. What has been the role of civil society in promoting equity-oriented
CPHC?

6. What has been the impact of the global economy on CPHC?

Methodology

7. How can equity in health outcomes be measured and attributed to CPHC?

Impact

8. How does the quality of CPHC affect health outcomes?

9. What has been the role of community health workers in CPHC programs and
related health outcomes?

10. What has been the effectiveness of CPHC in addressing gender and other
forms of social inequalities?

11. What has been the role of CPHC care in mobilizing civil society and
social movements relating to health?

12. How has 'ownership' by the community of CPHC services affected the
success or sustainability of CPHC?

Population- and Region-Specific Questions Identified from the Literature
Review

Research may also choose to address any of the following population- and

region-specific questions:

Aboriginal/Indigenous populations in Canada or Australia as well as in
project regions with Aboriginal/Indigenous populations)

1. What constitutes 'indigeneity' in CPHC?

2. What is the extent of control over CPHC exercised by Aboriginal
communities?

3. What are the similarities or differences between 'holistic indigenous
primary health care' and CPHC?

4. Should, and if so, how can, CPHC better link traditional indigenous with
modern Western health views?

5. How has colonialism affected CPHC development in Aboriginal communities?

6. What CPHC governance structure is most appropriate to Aboriginal health
beliefs and values?

7. How does CPHC deal with/overcome racism?

8. How does CPHC build or enhance community participation in Aboriginal
communities, with what impacts on health?

Latin America

9. What has been the impact of Cuban primary health care on equity in health
in that country?

10. What has been the political sustainability of CPHC in Latin America?

11. How has, or how could, CPHC moved beyond a targeted intervention for the
poorest to become a more universally accessed system for other groups?

12. How politically and financially sustainable over the longer term is a
CPHC focus on the poorest?

13. What role has CPHC played in dealing with health determinants residing
in the environment, urbanization processes, food access/security and
non-medical determinants?

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Africa

14. How have health programs receiving funds from Global Health Initiatives
for selected technical interventions to address one or two diseases
integrated (or not) actions dealing with social determinants?

15. How possible is it for a primary health care clinic to deliver CPHC?

India

All of the Indian/South Asian regional questions are the same as the 'Other
General Questions' noted above.

Proposed Venues and Dates for Regional Training Programs

Year 2008

Region 1: India and South Asia

Bangalore, India, 13-24 October 2008

Region 2: Africa

Cape Town, South Africa, 3-14 November 2008

Region 3: Latin America

Bogota, Colombia, 26 September - 7 October 2008

Region 4: Indigenous/Aboriginal peoples in Canada and Australia

Adelaide, Australia, 20-31 October 2008

Year 2009

Dates and venues to be determined for all regions

Year 2010

Dates and venues to be determined for all regions

Checklist

◘ Expression of Interest (maximum 5 pages in length).

◘ Curriculum vitae (resumé) of each team member.

◘ Signed statement from each team indicating commitment to attend all three
training programs.

◘ Signed statement from university of employer of each team member
indicating time will be granted to team members to attend all three training
programs and undertake research.

◘ A list of other collaborators the team has involved in its Expression of
Interest.

◘ If a mentor is identified, a letter from the mentor indicating willingness
to support the team over the three year period.
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