Issue 10 n July — September 1997 COHRED Reese int A · health economicsresearch programme in an aca-demic institution, and it was agreed that her main research would be into the

The Newsletter of the Council on Health Research for Development ( COHRED )

Issue 10 n July — September 1997

IN THIS ISSUE OF RESEARCH INT O A CTION

COHRED in Action

Country Update GHANA

AFRO–NETS

Upcoming Events

Publications

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C O H R E D

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THE critical assumption in proposinghealth system research for theimprovement of health policies—and,ultimately, for the betterment of thehealth of populations—lies in its abili-

ty to influence decision-making. In con-trast to the importance of this assumption, it issurprising how little is known about the processof how decisions are actually made in real life.This was illustrated at a recent meeting inHeidelberg, Germany (July 1997), on‘Strategies to enhance the use of research forhealth sector reform.’ Organised by the Institutefor Tropical Medicine and Public Health underthe auspices of the European Commission, deci-sion-makers and researchers from a series of

developing countries, including Bangladesh,Burkina Faso, Ghana, Mali, Tanzania, Thailandand Pakistan, presented and discussed successfulas well as unsuccessful cases of the use (or non-use) of research in health sector reform.

... Continued on page 2

HEALTH SECTOR REFORM:can research make a difference ?}The wor ld o f ideas and the wor ld o f act ion are not separate, but inseparable par ts o feach other . Ideas are t rue forces that change the tangib le wor ld . The man and woman ofact ion has no less responsib i l i ty to understand the wor ld , than the scholar .~

Donabedian, 1986

By RAINER SAUERBORN

From these case studies and arelated literature review, thefollowing critical issues in theuse of research for policy-mak-ing were identified:•DATA, including questions ofrelevance, reliability, validity,level of aggregation, etc.;

•COMMUNICATION OF RESULTS,with the two-culture metaphor‘action people versus data peo-ple,’ as main explanation;

•OWNERSHIP, covering ques-tions such as who sets theresearch agenda, who designs,who gets feedback, who drawsconclusions?

•INSTITUTIONAL FRAMEWORK,which refers to the type ofresearch institution, the type ofpolicy-making body and the

organisational arrangements

between them;

•ROLE OF RESEARCHER: detachedanalyst or involved lobbyist?

What about the decision-makingprocess itself?

The decision-making process is‘messier’ than the widely heldlinear model suggests. It can besidetracked and reversed andstopped at any time.

Research is but one input in theprocess, and certainly not themost important one. Thesocial/political dimension of the

decision-making process iscritical, yet the knowledge-dri-ven model does not acknowledgethis. In this light, we canunderstand how crucial it is that‘researchers’ be aware of the

political environment in whichdecisions are made.The concept of the decision-maker is misleading. Whilethere may be one institution orone person responsible to finallysign off on a decision, there mostcertainly are a great number ofstakeholders who have had theircrucial influence on the deci-sion-making process. The com-plexity and extent of the web ofstakeholders goes clearly beyondthe Ministry of Health, thehealth practitioners, and thecommunities often cited as the‘key players.’ Media, unions,multilateral institutions, indus-try, political parties, NGOs, allhave their stakes in many healthsector policies and thus try toinfluence the decision-making

process. Researchers are welladvised to get to know the com-plex web of stakeholders andtheir conflicting views andinterests, and to use researchresults to influence the mostimportant ones.

Acknowledging that informationis but one of many inputs in thedecision-making process, andthat knowledge of the policyprocess, the key stakeholdersand their roles in the policyissues under scrutiny is a pre-requisite for improving the useof research, we identified a setof strategies aimed at enhancingthe use that policy-makers makeof their research results. Thesestrategies fall into seven cate-

Council on Health Research for2

Health Sector Reform ... continued from page 1


The KnowledgeThe Knowledge-Driven Model-Driven ModelKnowledge

Decision

Judgement

Understanding

Knowledge

Information

Data

Processing

Valuation

Weighing options

Interpretation

Analysis

Sorting /

CollectionAdapted from van Lohuizen (1985)

C o n c e p tC o n c e p t

StrategiesStrategies

Decision-makingDecision-making

gories:

I Sensitisation of stake-holders to the usefulness ofresearch results to increasethe demand for and use ofapplied research in their work;

II Sensitisation ofresearchers to their advo-cacy role: fostering his/herinterest and commitment to‘feed’ the research results intothe decision-making process;

III Ownership of the researchagenda and results. This implies

that key stakeholders areincluded not only in the selectionof research questions, but in

their design and the continuousfeedback and discussion ofresults;

IV Creation of appropriateinstitutional arrangementsfor a continuous dialoguebetween researchers and keystakeholders;

V Attention to data quality(relevance, timeliness, validity,reliability, generalisability);

VI Appropriate communica-tion of research results, toas many stakeholders as possi-

} Researchers should

reassess their roles and

consider themselves as

lobbyists for their

research conclusions. ~

RESEARCH INTO A CTION Issue 10 n July — September 1997 3

community

health practitioners

religious groups

finance ministry special interests

political parties

donors/TA unionsNGOs

MOH media

peers

r e s e a r c h policy decisions

Rainer Sauerborn, MD, Dr. PH, is Director of the Department of Tropical Hygiene and Public Health,Ruprecht-Karls University of Heidelberg.

Contact address: Prof. R. Sauerborn, Department of Tropical Hygiene and Public Health, Ruprecht-Karls-UniversityHeidelberg, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany. Tel 49-6221-565 033 ¥ Fax 49-6221-565 948 ¥

E-mail: [email protected]

COHRED IN ACTION

COHRED

COUNTRY THE CONCEPT


health insurance association for one district inline with the consensus reached during a two-day seminar on health insurance.

Although the project was successful in influ-encing broad policy decisions, as a result ofmany changes in staffing at the ministry and inthe local offices of donors it has been unsuc-cessful in terms of bringing about rapid intro-duction of the new scheme. However, it is worthexamining the steps by which this research pro-ject was carried into effect and its results weredisseminated.

DATA CHARACTERISTICSThe data characteristics of this project may besummed up as follows:

Research• • Community/rural health insurance in Africa

and its specific feasibility in Ghana•• Fieldwork in Burundi, Guinea-Bissau and Ghana•• Sponsors: Overseas Development

Administration (ODA), InternationalDevelopment Research Centre (IDRC),United Nations Children’s Fund (UNICEF)

Policy Background••User fees and the problem of poor access by

impoverished groups to health care

Policy Decision•• To include rural/district health insurance in

the health financing strategy

•• To launch pilot scheme(s) in specific districts

Summary of Events1988 Conception1989-90 MSc training for the Principal

Investigator (PI)1991 Literature review, methodology devel-

opment, writing of proposal1992 Preparatory studies in two other African

countries1993-94 Fieldwork in Ghana1995 Dissemination workshop in Accra,

international presentations and publica-tions.

Institutional FrameworkThe conceptual framework and policy back-ground of the project from the outset in 1988was the issue of user fees and the problem ofpoor access to health care for people with low oronly seasonal incomes, especially those living inrural areas. The Director of Medical Services,who had earlier been the Director of the PlanningUnit, proposed that the Unit should explore thefeasibility of introducing health insurance forthe informal sector and for identifiable groupssuch as farmers’ associations. Recognising thatthe health economics knowledge and skills forstudying this issue were lacking, he encour-aged a member of the Unit’s staff, who wasalready interested in health financing, to concen-

+ + +

COUNTRY UPDATE

AA


One of the challenges facing Ghana was how to organise the community financing ofhealth care in such a way that it would not deter the poor and vulnerable from seek-ing that care. As early as 1988 a key policy-maker, the then Director of MedicalServices (DMS), was sufficiently concerned about this to support a research projecton ‘the demand and willingness to pay for rural health insurance.’ Subsequently the

trate on health insurance and supported herapplication for an MSc in health economics.The Principal Investigator was seconded to ahealth economics research programme in an aca-demic institution, and it was agreed that hermain research would be into the feasibility ofinformal/rural health insurance in Africa, withparticular emphasis on Ghana. Effective collabo-ration existed between the PI and the academicinstitution, the Ministry of Health (MOH) anddonors supporting the work (IDRC and UNICEF)because of the role of the DMS in the research. Asone of the advisers of the research, he was ableto explain its importance to the Ministry and torequest donor assistance. This situation fosteredan effective collaboration between policy-makers, researcher and donors. The link betweenthe research findings and policy wasfurther helped by the presenta-tion and discussion of the findings at aworkshop attended by senior officialsfrom relevant ministries.

In translating the concept into develop-ment, the role of the policy-maker — inthis case the DMS — entailed:

•• recognising the need to explore solu-tions to the health insurance prob-lem

•• ensuring that there were the requisitehealth economics knowledge and skillsin the Planning Unit

•• making sure that any potential for poli-cy-making was built into the researchdevelopment.

The role of the researcher was, in responseto the policy-maker’s concerns:

• • to acquire health economics skills

• • to summon up academic support for theresearch — in other words, to act as a lob-byist

• • to develop the research in collaborationwith other interested parties. In practice,this collaboration involved three actors: theMinistry of Health, the PI/ academic insti-tution and the donors.

Communication of ResultsThe results of the research were disseminatedthrough a workshop held in Accra and attended bysenior staff of the MOH and of relevant min-istries. Besides the research report for thedonors, a briefing paper for policy-makers wasproduced, and a summary was published in anewsletter which was given wide circulation.

Follow-up activities involved putting rural

health insurance firmly on the policy agenda.However, a change in the main policy-makersresulted in a shift away from a scheme based onrural solidarity and towards a scheme based onformal or semi-formal commercial links.

T H E R E S U L T SThis case study of a research project to examinerural health insurance as a health financingoption in Ghana illustrated both positive and neg-ative experiences in the interaction betweendecision-makers and researchers. Today it can besaid neither to have failed nor to have succeeded.

The project has been successful in keepingcommunity-based health insurance as a financing

option firmly on the MOH research agenda.Decision-makers have actually decided to pilotthe feasibility of this approach in selected dis-tricts across the country.

It has been unsuccessful in that it has notmanaged to keep key decision-makers interestedin the community-based approach, even though ithas the potential to resolve the problems ofsome three-quarters of Ghana’s population wholive in rural areas. Attention has turned insteadto commercial approaches to health insurance.One of the major reasons for this is that certainkey changes of staff at the MOH have beenaccompanied by changes in philosophy.

L E S S O N S L E A R N E DResearchers have to keep pace with possiblechanges in decision-makers, and foresee the

Source: Human Development Report 1997, United Nations Development

16.9 million

56.6 years

740

79

130

44

93

60

65

55

63.4

25,000

410

1.7

3.1


G h a

Ghana ... continued from page 5



News From ENHR Partners

Avoiding the need ‘to re-invent the wheel’ was oneof the reasons for establishing AFRO-NETS. In1996, scientists, health workers and representa-tives from NGOs realised that several ‘networks’active in health research and development wereoperating independently from each other on theAfrican continent. To avoid duplications and savescarce resources, the group decided to set up a‘Network of Networks’ which it hoped would leadto better collaboration between the networks incapacity building, planning and conductingresearch, transforming research recommenda-tions into action, and many other areas. To date, 14 networks and institutions are partici-pating in the ‘Network of Networks’. The ‘elec-tronic conference’ has about 400 direct sub-scribers, of whom half are located in Africa, andthe other half in the United States, Europe, Asiaand South America. (In Africa, messages are alsobeing fed into local ‘HealthNet’ nodes from where

they are distributed to country-wide mailing sys-tems (e.g., in Zimbabwe to the more than 200subscribers of ‘HealthNet Zimbabwe’)). The conference also serves as a forum forannouncing meetings, training courses, newteaching materials and other items of interest tothe networks.Traffic on the electronic conference is moderate tolow, depending on the topic being discussed.Whereas the discussion about the introduction of anew ‘Health Card’ generated up to 10 messages aday (and a total of 60 messages), the averagenumber of contributions is two or three a day. Thediscussion topics deal with every aspect of healthresearch in Africa, from AIDS to capacity build-ing, from the Internet and traditional healers toZambian women’s groups.The conference is moderated. In other words, eachmessage is checked andapproved before being sent ...Continued on page 8

Sister Dora S. from a rural District Hospital in a Southern Africa country had a problem. During a‘Reproductive Health Workshop’ conducted in a remote village, ‘poverty’ had been identified as one of themajor causes of ill-health in the community. Now Sister Dora was looking for information from non-govern-mental organisations (NGOs) involved in income-generating projects, specifically projects targetingadolescents.Eventually she remembered that her Hospital was connected to ‘HealthNet’ — an electronic information system— designed to serve health workers labouring in isolation from one another. HealthNet is running an electronicconference, called ‘AFRO-NETS’ — African Networks for Health Research & Development — which was set upto encourage and facilitate collaboration among various NGOs, research centres and governmental organisationsactive in health research for development in the Eastern and Southern Africa Region.sister dora sent out a short message on AFRO-NETS, asking for information about income-generating activitiestargeting adolescents. within a few days she received several responses from all over the world, giving heruseful contacts or concrete examples and experiences, with lessons learned, so she did not need to ‘re-inventthe wheel’.

has been set-up to facilitate theexchange of informationbetween different networksactive in Health Research for

Development in the Eastern and Southern African Region. Itis a forum for discussion which can support collaborationbetween the networks in such fields as capacity building,planning and conducting research, transforming researchrecommendations into action, and so forth.

We want to hear from you, so please share your com-ments, ideas and questions!

To subscribe to the Afro-nets conference, send e-mail to<[email protected]>Include the following command in the text of your message:

subscribe afro-netsend

For a full “help” text, include the following in the text ofyour message:

helpend

To retrieve the daily archives, include the following com-mand in the text of your message:

get afro-nets topicsend

This retrieves a table of contents of all postings for thecurrent calendar year, showing the subject lines and filenames.Next, send another message [email protected] include the following command in the text of your mes-sage:

get afro-nets YYMMDDHHMMSSend

(YYMMDDHHMMSS represent numbers for the year, month,day, hour, minute and second)

A digest version of Afro-nets is also available. Send e-mail to <[email protected]>Include the following command in the text of your message:

subscribe afro-nets-digestend

You may also read the conference via SatelLife’s WorldWide Web at

http://www.healthnet.org/afronets/

For additional assistance in subscribing, contact: [email protected]

To send a message to the conference, prepare an e-mailmessage to

[email protected] then type your com-ments in the body of the

Contact : Dr Dieter Neuvians, MCH/FP, GTZ, P.O. Box 2406,Harare, Zimbabwe. Tel 263-4-733 696 • Fax 263-4-733 695or 304 926

out to the subscribers. This is not censor-ship, but a sorting out of administrativerequests (e.g., for subscription), auto-matically generated messages (I am onleave until...), and personal messages(aren’t you the one I recently met in CapeTown...?), which account for up to 20% ofall messages. It is meant to avoid unneces-sary traffic, which is important for thosewho have to pay for every single messagereceived.Since two or three messages a day mightstill be an inconvenience for some sub-scribers, an AFRO-NETS digest was creat-ed, which collects 8 to 10 messages andsends them out to the subscribers of thedigest as one message once or twice aweek. In addition, research proposals,research results and other documents arebeing stored at the central computer, fromwhere they can be retrieved via e-mail byanybody interested in them.AFRO-NETS maintains a ‘Home Page’ atthe World Wide Web server ofHealthNet/SatelLife in Boston, USA. Allcontributions made to the electronic con-ference can be searched by keywords andretrieved via the integrated ‘WebGlimpse’search engine. ParticipatingNetworks/Institutions are listed on thehome page with their ‘hyperlinks’ (click-ing their name with the mouse brings the‘Web-Surfer’ to their own home page).HealthNet/SatelLife has recently developeda free ‘GetWeb’ service which allowseverybody with an e-mail account todownload documents from the World WideWeb. This is important for health workerswith no direct Internet connection (themajority in Africa), who can now even doa (free-of-charge) MEDLINEsearch via e-mail.Launched in November 1996, AFRO-NETSnow provides a forum for informationexchange and connectivity for the partici-pating individuals and organisations,either based in Africa or working inAfrica, including WHO, the World Bank,the US Agency for InternationalDevelopment, the European Commission,the US Centers for Disease Control andPrevention, and UNICEF.‘AFRO-NETS is especially significant forSatelLife because it is a conference developed


AFRO-NETS ... continued from page 7

This Report was written for Research into Action by Dr Dieter Neuvians,based in Harare, Zimbabwe, and currently working as consultant for a

GTZ-supported Health Systems Research Programme in the Eastern andSouthern African Region.

The

AFRO-NETSconference

R E L E V A N C E O F T H E S T U D Y

Significant user charges for health services at the point of use were introduced in Ghana in 1985. The leg-islative instrument which brought the hospital fees act into being stipulated that the full cost of pharmaceuti-cal drugs was to be recovered by the user, although this opened the door to increases in drug prices in linewith increasing inflation. But the other fees were supposed to remain unchanged until another legislativeinstrument could be produced. Over the years there have been increases in charges for non-drug items aswell as for drugs, usually at the discretion of service providers.

As a consequence of these user charges, the poor and those who happen to be without money at the time ofneed are denied equitable access to the health service. There are increasing public complaints about the highcost of health services relative to the incomes of the average Ghanaian.

At the same time, the government cannot afford to provide completely free health services, and some con-tribution by users is needed. Health insurance is one of the possible financing alternatives that the MOH hasseriously considered instead of fees at the point of use. One problem with this option is that it is noteasy to work out a viable system in rural areas where many people are not in formal employment, cash flowis low and incomes are seasonal.

To make the results of this particular study more useful to policy-makers, the research methodology shouldbe closely examined for its viability. Specifically, although many people to whom the unfamiliar concept ofhealth insurance was introduced said they would pay in theory, it is not sure that this would happen in actualpractice. Levels of poverty are high in Ghana and, as the study itself demonstrated, many citizens are innegative cash balance at the end of the year.

In order to more effectively inform national policy-making, similar studies should be made in parts of thecountry which differ from the study area, to determine whether the results are similar. Since the researchdid not deal with the organisation and administration of the scheme, there is a gap in the information provid-ed.

In the light of the above, thecurrent decision of the poli-


Ghana ... continued from page 6

Carnegie Corporation of New York — USA

International Development Research Centre, IDRC —

Canada

Department for Research Cooperation, SAREC, Swedish

International Development Cooperation Agency, Sida —

Sweden

Directorate-General for International Cooperation, DGIS,

Ministry of Foreign Affairs — The Netherlands

Norwegian Agency for Development Cooperation, NORAD

— Norway

Swiss Agency for Development and Cooperation, SDC —

Switzerland

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This article is based on a presentation by Dr I. Adjepong and Dr D. Arhin, Health Research Unit, Ministry of Health, Accra,Ghana, at the International Conference on Strategies to Enhance the Use of Research for Health Sector Reform, held in

Heidelberg, Germany, 24 to 26 July 1997.It was written for Research into Action by John H. Bland, a former Editor-in-Chief of WHO s World Health magazine.

Contact: Dr S. Adjei, Director, Health Research Unit, Ministry of Health, PO Box 184, Accra, Ghana.Tel 233-21-230 220 ¥ Fax 233-21-226 739

Fourth Canadian Conference onInternational HealthOrganisers: Canadian Society for InternationalHealth and Canadian University Consortium for Healthin Development in collaboration with the CanadianPublic Health AssociationLocation: Palais des Congrès, Ottawa/Hull, CanadaContact: Conference Coordinator, Canadian Societyfor International Health, One Nicholas St, Suite 1105,Ottawa, Canada K1N 7B7. Tel 613-241 5785, ext 313• Fax 613-241 3845 • E-mail: [email protected]: Organised around the them ‘Women,Health, and Development,’ this year’s conference willdiscuss and assess field-based activities of Canadianorganisations and results of research carried out byCanadians and Canada-supported developing countryresearchers. Sub-themes will include: gender as adeterminant of health; reproductive health; safe moth-erhood; human rights; addressing violence

4th International Course onthe Anthropology of Healthand Health CareDates: 7 February to 19 March1998Location: Bangladesh RuralAdvancement Committee (BRAC)Centre, Dhaka, BangladeshContact: The Director Research,BRAC, 75 Mohakhali C.A., Dhaka-1212, Bangladesh. Tel 880-2-884180-7 • Fax 880-2-883 542/883614/886 448 • E-mail: [email protected]: The course isdesigned to provide junior social sci-entists and public health profession-als with: understanding of anthro-pological concepts used in the analy-sis of health problems knowledge ofand experience with methodologicaltools for applied anthropologicalresearch in the health field ability to


UPCOMING EVENTS

APRIL 21 – 24,

N O V E M B E R 9 — 1 2 , SEPTEMBER 14 – 18,

M E E T I N G S & C O N F E R E N C E S

COURSES

2nd European Congress on TropicalMedicine4th Residential Meeting of the Royal Society ofTropical MedicineOrganiser: The Royal Society of Tropical Medicineand Hygiene and the Federation of EuropeanSocieties for Tropical Medicine and InternationalHealthLocation: University of Liverpool, main campusContact: European Congress Office, LiverpoolSchool of Tropical Medicine, Pembroke Place,Liverpool L3 5QA. Tel 44-151-708 9393 • Fax 44-151-708 8733 or 708 9007 • E-mail:[email protected]: Hosted in Liverpool on the occasionof the celebration of the Centenary of the LiverpoolSchool of Tropical Medicine, the Congress, whichwill include 12 Plenary sessions, several

Eighth Public Health Forum ‘Reforming Health Sectors’Organiser: London School of Hygiene and Tropical Medicine (LSHTM)Location: London School of Hygiene and Tropical MedicineContact: Alice Dickens, Conference Organiser, L S H T M, Keppel Street, London WC1E 7HT, UK. Tel44-171-927 2314 • Fax 44-171-580 7593 • E-mail: [email protected]: Academics and practitioners from all parts of the world will discuss the following questions:Should the state do less? Can we learn from the UK reforms? Can technical analysis improve reform design andimplementation? The needs of the poorest: are they being ignored? Where can the money be found? Public orprivate: an irrelevant question? Does understanding politics help in implementation? The future health system:what will it look like? The Conference will be of interest to any one who is involved in designing, implementing

Courses offered by Swiss TropicalInstitute (STI), PO Box, CH-4002Basel/Switzerland, Tel 41-61-284 82 80 •Fax 41-61-284 81 06E-mail: [email protected]://www.wb.unibas.ch/STI

Health Care and Management inTropical CountriesDate: March 16 – June 4, 1998Location: Swiss Tropical Institute, Basel,SwitzerlandDescription: A three-month full-time diplo-ma course for experienced professionalsinvolved in health and development activitiesor planning to work overseas. Interactiveteaching-learning methods (case studies,group work and presentations (English/Coursefee CHF6000). Number of places limited.Application deadline is 30 September 1997.District Health ManagementDate: June 8 – 26, 1998Location: as above.Description: Certificate course. Topics:Project planning; adapted, modern manage-ment of human, material and financialresources. (English/Course fee CHF2100).

Application deadline is 31 March 1998.Medical Practice in DevelopingCountries with LimitedResourcesDate: approx. July/August 1998Location: Rural AfricaDescription: Certificate course.Topics: Design, application and evalua-tion of diagnostic and curative proce-dures of clinical tropical medicine in dis-trict hospitals in tropical countries.(English/Course fee CHF2100)Application deadline is 31 March 1998.Travellers’ HealthDate: September 21 – 25, 1998Location: Swiss Tropical Institute,Basel, SwitzerlandDescription: International short (cer-tificate) course. Topics: Prevention andcure of travel-related problems withspecial focus on tropical diseases.(English/Course fee CHF800)Application deadline is 15 August 1998.Accidents due to Venomous andPoisonous AnimalsDate: September 28 – October 1, 1998


PRIVATE HEALTH PROVIDERS IND E V E L O P I N G C O U N T R I E S: Serving thepublic interest?Edited by Sara Bennett, Barbara McPake, andAnne Mills. Zed Books, London and New Jersey,1997. ISBN 1 85649 496 9 Pb.This book presents the results from a coordinatedprogramme of research on the private health caresector including studies carried out by Asian,African and Latin American researchers. It isstructured around three main themes — thebehaviour and performance of private sectorproviders; the market situation in which they findthemselves; and the experience of incorporatingprivate sector providers into public sector activ-ities through contracting. The book will be usefulto students and academics involved in internation-al public health courses, and to health policy mak-

M O N E Y A N D F R I E N D S H I P. Modes ofEmpowerment in Thai Health Care. By AnneV. Reeler. Het Spinhuis Publishers, Amsterdam,1996. ISBN 90-5589-076-6. 182 pages.US$17.50. The book is published in the seriesHealth, Culture and Society: Studies in MedicalAnthropology & Sociology.The author, who is an anthropologist currentlyworking for UNAIDS in Geneva, describes howpeople actually try to empower themselves inrural and urban situations in northeast Thailand.The book goes beyond simple relativism by show-ing how structural conditions frame people’shealth-seeking practices. It also contributes tothe discussion about the extent to which healthworkers and planners should ‘compromise’ onbiomedical standards and ideals in order to allowpeople to participate in their own health care inways they find meaningful. The book can beordered via Martinus Nijhoff International, POBox 269, 2501 AX The Hague, The Netherlands,or directly via Het Spinhuis Publishers, Oudezijds

H U M A N D E V E L O P M E N TR E P O R T 1 9 9 7. UnitedNations DevelopmentProgramme, New York. OxfordUniversity Press, 1997. ISBN0-19-511996-7 (cloth), ISBN0-19-511997-5 (paper).The theme of this year’s reportis poverty from a human devel-opment perspective, that ispoverty as a denial of choicesand opportunities for living atolerable life. It introduces anew measure — the “HumanPoverty Index” (HPI). Thismeasure is based on three vari-ables: the percentage of peopleexpected to die before age 40,the percentage of adults whoare illiterate, and the percent-age of people without access tohealth services and safe waterand the percentage of under-weight children under five. Thisis a departure from the conven-tional measures which are basedon income only.Like its seven predecessors, the1997 report is the outcome of acollaborative effort of a panelof eminent scholars and theUNDP Human DevelopmentReport team. To orderthe English version, con-tact Oxford UniversityPress, Walton Street,Oxford OX2 6DP, United

ENHR IN KENYA. Executive Summary.Concept Papers Meeting for EssentialNational Health Research (ENHR) in Kenya,Nairobi Safari Club, 23-24 April 1997. Compiled byM.S. Abdullah, R.N. Oduwo, Y. Kombe and F.A. Opondo.ISBN 9966-9927-1-5. For copies, write to:Secretariat, National Health Research & Development

Newsletters FFF

A SIM P L E S O L U T I O N. Teaching Millionsto Treat Diarrhoea at Home. By A.Mushtaque R. Chowdhury and Richard A. Cash.With a Foreword by Jon E. Rohde. UniversityPress Limited, Dhaka, Bangladesh, 1996. ISBN984 05 1341 9. 149 pages.The book relates how a medical technology wasadapted, revised and successfully introduced on alarge scale to an illiterate population inBangladesh through house-to-house health educa-tion by a small group of dedicated health workers.The authors have painstakingly documented one ofthis century’s major public health achievements

The time has come to createa world that is more humane,

more stable, more just

Please note, COHRED cannotsupply the publicationsreviewed on this page.

Please write to the appropriateaddress.

PUBLICATIONS

This newsletter of the Council on Health Research for Development ispublished four times a year.Printed on recycled paper, RESEARCH INTO ACTION is issued compli-mentary upon request.

COHRED, c/o UNDP, Palais des Nations, CH–1211 Geneva 10,Switzerland;Tel (41 22) 979 95 58 • Fax +(41 22) 979 90 15 • E-mail:


COUNCIL ON HEALTHRESEARCH FOR

DEVELOPMENT

COHRED

Editor in Chief:

Editing, desk-top com-position and layout:

Yvo Nuyens, Ph.D.

Hannelore Polanka, M.A.

Information BulletinThis three-language (English, French, German) bulletin is published twice a year by the Standing Committee ofthe Hospitals of the European Union (HOPE). It updates readers on recent developments in the health-care andhospital-care sectors in HOPE’s member countries and the European Union. It also provides other European andworldwide news, for instance, on activities of the Council of Europe and of health-related European and inter-national organisations. A special column spotlights individual European countries and affords informativeoverviews of how health care is organised at the national level. For more information, contact StandingCommittee of the Hospitals of the European Union, Kapucijnenvoer 35, B-3000 Leuven. Tel 016/33.69.02 •Fax 016/33.69.06 • E-mail: [email protected]

DHS NewsletterThis 12-page newsletter is published twice a year by Macro International Inc. to provide information about theDemographic and Health Surveys (DHS) programme which it is implementing, and about the current status ofDHS surveys. The Programme assists developing countries to conduct national surveys on population andmaternal and child health. To receive the DHS Newsletter, write to: Tonya Gary, DHS, Macro International Inc.,11785 Beltsville Drive, Suite 300, Calverton, MD 20705, USA. Tel 301-572 0958 • Fax 301-572 0993 • E-mail: [email protected]

Speaking About RightsNewsletter of the Canadian Human Rights Foundation (Bilingual, English and French). Subscription fee: CdnUS$15/year. Canadian Human Rights Foundation, 1425 René-Lévesque Blvd West, 307, Montréal, Québec,Canada H3G 1T7. Tel 514-954 0382 • Fax 514-954 0659 • E-mail: [email protected] • Internet:http://www.web.net/chrf-fcdp

NU — News on Health Care in Developing Countries

COHRED, the Council on Health Research for Development, is a non-govern-mental organisation. It was established in March 1993, and is located in theEuropean Office of the United Nations Development Programme in Geneva,

Switzerland.

The Council consists of member countries, agencies, organisations and an18-member board, the majority of whom are from developing coun-

tries.

Its objectives are to promote the concept of Essential NationalHealth Research (ENHR), which aims to assist countries inidentifying their health and research priorities as well asstrengthening their research capacities, and encouragesmulti-disciplinary and multi-sectoral collaboration

to ensure that health policies and decisions onimportant health issues respond to the actualneeds of the public and will translate into

Newsletter

Documents

Issue 10 n July — September 1997 COHRED Reese int A · health economicsresearch programme in an aca-demic institution, and it was agreed that her main research would be into the