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Health Information Forum: Working together to improve access to reliable information for healthcare workers in developing and transitional countriesWorkshop 8: Cooperation with DFID and WHOREPORTBritish Medical Association, London, Tuesday 16th November 1999, 4-6pm Chair: Richard Smith (Editor, British Medical Journal) Participants:
SESSION 1: The DFID 'Health Communications Partnership' Note: The Final Report, Annexes, and Supplementary Report of this study are now available in full text at <http://www.ids.ac.uk/healthcomms>. 1A: The DFID/HPD Health Communications Partnership Study: Outline of the process (Andrew Chetley, Healthlink Worldwide) The study embraced the full range of health communications activities, including social marketing and public awareness. Information for healthcare workers was recognized as an important part of this scope. The study was carried out on three key premises:
A Working Group was established to produce recommendations on: how to improve effectiveness of existing communications efforts; which organisation(s) are best placed to work in partnership with DFID to meet its Health and Population Strategy; what form partnership should take, including its management; and the scope, including resource requirements, for a DFID/HPD Communications Partnership. The Working Group members were: Gordon Adam (ICHR Radio Partnership), Andrew Chetley (Healthlink Worldwide), James Deane (Panos London), Pat Norrish (AERDD, Reading University), Neil Pakenham-Walsh (INASP-Health), Sue Warwick (Marie Stopes International), Geoff Barnard (IDS), and Jo Bexley (UNICEF-UK). Geoff Barnard and Jo Bexley were Manager and Coordinator, respectively. The process was as follows: Sep 98 Working group established Sep-Dec 98 Working Group met 4 times Jan 99 Consultation workshop (50 organisations attended) Feb 99 Final Working Group meeting and draft report circulated to participants Mar 99 Report submitted May-Sep 99 Discussion of report within DFID Sep 99 Working group asked to prepare supplemental report Oct 99 Working group prepares and submits supplemental report Nov 99 Response from DFID Findings The UK Health Communications Sector was noted to be:
The sector has many real strengths, but there are undoubtedly many areas where its effectiveness and impact could be improved. Recommendations The Working Group outlined four proposals for addressing the issue. DFID selected one of these as the way forward and asked for a further elaboration of what it might look like. Level 2 Proposal: £250-500k/yr 'Ambitious networking and learning programme' The Programme would focus on 3 closely related roles:
It would seek to provide:
In doing so, it would:
Expected outcomes
Winning the trust of the health communications sector will be essential. The process of developing the Programme has been deliberately open and participative up to now. It will be important to build on this, and to maintain this approach in taking plans forward. From indications so far, the Programme will be very much welcomed by the sector provided that it:
1B: Statement from DFID (Stephen White, Head, Knowledge and Partnerships, Health and Population Division, Department for International Development) Working in partnership is a core element of the 1997 White Paper – the means by which DFID will contribute towards achievement of international development targets. Whilst DFID has always had relationships with other donors and low income countries, partnerships with the private sector and civil society is a new and radical shift, but one that is key to a more strategic, collaborative approach geared to making real changes to the health – and subsequently livelihoods – of poor people. This is a new shift and requires new working relationships. Partnerships represent a move away from the old client/contractor relationship to one where DFID does not run the agenda but is merely one voice, albeit valued and important, at the table. These new relations will not be put in place overnight, but will be an organic process – both DFID and those we work with will have to learn from each other as we go along. But I do want to emphasise that this means we will be taking a much more hands-off approach and looking to our partners – in this case in the area of health communications – to take the lead. Now I want to turn to the report itself. The Working Group has done an excellent job in articulating the case for a 'Networking and Learning Programme'. The process also enabled the entire communications field to meet for the first time and this has produced a valuable piece of work. This is clearly an important area for DFID to support. I have little to add to the report itself. I would just like to reiterate that the intention is to move away from piecemeal support of small initiatives to a more strategic framework. We accept the broad conclusions of the report. The key question now is where we go from here. We now need to focus on how to get the programme up and running, to capitalise on the momentum generated by the work so far to identify the mechanics of setting the programme up. We have asked the Working Group to suggest a suitable organization in which to base the suggested 'semi-autonomous unit'. We do feel it is important that this comes from the group as a whole – a peer appointment rather than a DFID crony. If anyone has a view on suitable organizations please contact Geoff Barnard <[email protected]> by 1st December. We would then seek to identify someone from that organization to develop an operational plan, under the oversight of a transitional steering group. We think this should probably comprise the original Working Group together with representative(s) from DFID. Again, I would be grateful if any views on this could be passed to Geoff Barnard. The terms of reference for this piece of work will be drawn up over the next few weeks by Geoff Barnard and DFID. Timing on all this is subject to how quickly we can identify the appropriate organization/individual. But we would hope to see work start on the operational plan early in the new year with the programme – in embryonic form at least – commencing in early April. I should again stress how we see DFID's role. We will be a partner – a member of the Steering Group for the programme, but with a light touch. We will not chair meetings nor independently set the working agenda. The programme will not be 'DFID's poodle'. We will, of course, be an important source of funding initially but, if the programme works as envisaged, it would create greater synergy and drawing in of other partners and we would see it gradually drawing on funding from a range of other sources. Finally I would like to thank the Working Group and look forward to forging a valuable partnership with benefits for all concerned. 1C. Plenary discussion Liz Woolley enquired about how the success of the programme activities would be evaluated. Reply: It was up to the steering group to develop the operational plan. DFID would be 'just a voice' at the table rather than leading the agenda. At the moment there was no blueprint – we are starting on a learning process. It would be a part of the Steering Group's tasks to put evaluation into place and develop clear measures of effectiveness and success. Caroline Hyde-Price asked if similar models from other sectors had been identified. Reply: Although other Departments within DFID were seeking similar partnership arrangements the Health and Population Department were well advanced in their thinking, but lessons from other internal departments would be taken into account. Carolyn Sharples pointed out that the first meeting to address the issues of a collaborative approach had met over 5 years ago. She wanted to see practical results. It would be helpful to know who was in the Forum and what they did. Reply: The first time that the broader community (ie health communications generally) of interested parties had got together was in January 1999. The key activity of the programme would be to encourage interaction and complementarity, for instance those working in the same country. We needed case studies and learning from experience, sharing of successes and the not-so-successful projects. Carolyn Sharples suggested that we had not yet achieved the proper meshing of agencies and suggested the Internet might prove a useful medium for exchanging information on what everyone was doing. Gerry Dingley agreed with the above. He would like information on potential collaborators, e.g. niche suppliers. There was a need to get together to service the whole. John Harvard (Commonwealth Medical Association) raised the issue of poverty and the need to inform the general population so that they might improve their own health. Many of the poorest groups were illiterate and he felt that a broad brush approach to information and social development was needed. Reply: The particular type of partnership that DFID wished to achieve was one which would develop in ways that were wanted by the type of organizations that were involved in health information. One of the measures of success for the partnership would be if it delivered what was needed. It was important that the partnership should meet the needs of people in poor countries as well as the whole communication community. The proposal was deliberately vague at this stage, but now there was a mechanism to take it forward and a broad approach to health information would be adopted, going beyond that needed by health workers. Richard Smith emphasized that the partnership should be a consumer driven enterprise and that feedback from and through NGOs in this respect was important. Douglas Buchanan pointed out that DFID had people in the field who could contribute to this monitoring and feedback process. Alexander Heroys asked what the next step would be. Reply: An organization in which the partnership would be based would be identified, the steering group would draw up an operational plan in the new year, and the necessary staff would be appointed around April 2000. Neil Pakenham-Walsh asked whether the parallel 'Funding Programme', which had been a part of the most popular model discussed at the January 1999 meeting, was still under consideration by DFID. Reply: At this stage DFID did not want to create just another conduit for resources. The Networking and Learning Programme was intended to create greater synergy in the field of health communications. The first step would be to introduce the programme and the situation would be reviewed in due course. Liz Woolley asked whether the Health Information Forum would be subsumed by the Networking and Learning Programme. Reply: The Health Information Forum would continue in its own role and its activities would not be subsumed in the proposed Programme. The network and learning programme aimed to help and strengthen existing networks and build bridges with other sectors. Other networks were the Communications Initiative, HIV/AIDS networks, and reproductive health networks. There are also a number of organizations involved in health whose remit extended into information though this was not their primary objective. Links with these organisations should also be strengthened. David Bramley asked about proposed activities. Reply: At this stage nothing had been decided, but they would be based on the activities wanted by participants in the network and learning programme. Filling gaps was an objective, but at the moment the gaps themselves are unknown since we do not know what everyone is doing. Philippa Saunders (Essential Drugs Project) asked if the identification of a host organization was to be a tendering process. Reply: DFID did not want to introduce more bureaucracy than was necessary. If there were a clear consensus of opinion, there need not be a tendering process. On the other hand if there were several strong contenders then it would be considered. Shyama Kuruvilla (WHO) commented on the profiles of participants (as prepared on a handout). She noted that many people were at the meeting as individuals and wondered how far organizations were officially represented. Reply: Neil Pakenham-Walsh replied that the Forum is a meeting point, supported by INASP-Health services (advisory and liaison service; INASP-Health Directory; INASP Newsletter; contacts database). All participants come and go as they please, either as individuals or as representatives of their organisations. Over one hundred people had come to at least one Forum meeting and there is a core of regular attenders. The purpose of the Forum is to facilitate the pursuance of common interests, but it is neutral and does not carry out health information activities itself. Subgroups can be formed for more intensive discussion of a subject, which might or might not generate ideas for projects. Validation, consensual support for, or implementation of such projects, however, is outside the capability and remit of the Forum. The Forum's main purpose in this context is to provide a neutral space for feedback and advice from individual participants. Richard Smith summed up the day's presentation and discussion: The problem is to determine the best way of tackling the problems of health information in developing countries within the resources available. There is a great diversity of organizations involved, and the general consensus of opinion is that we could be more effective through collaboration, evolve a better and more creative way of working together and hence get a bigger bang for the buck. It was good news that DFID was putting in resources to achieve this cooperation, and interesting that they expected to be just a voice at the table rather than being in control of the process. The Networking and Learning Programme should follow the objectives described by Andrew Chetley, and encourage information exchange both in and between developing countries. SESSION 2: General HIF announcements Open Forum The next Open Forum meeting would take place in May. Those interested to give a short presentation or poster on their activities/organization, please contact Neil Pakenham-Walsh at < [email protected] >. Staging Posts Action Group (SPAG) Chris Zielinski summarized the history and status of the Staging Posts Action Group. He noted that the group would be meeting shortly to decide on how it wished to proceed now that the discussion of the Information Waystations project had moved outside the Health Information Forum in preparation for phased implementation. Chris announced that he had secured funding for a 9-month part-time research phase that would conclude with the issuance of a directory of health information resource centres throughout the world, covering their policies, aims, priorities, staffing and funding levels and technological capacity. The funding was being provided by the Seattle-based PATH Child Vaccine Initiative (and thus indirectly by the Gates Foundation, which funds PATH). This funding will cover the costs of all work, including travel to one or two particularly relevant meetings and to donor foundations that may be able to fund the full Information Waystations project. He would shortly be writing to all Staging Post Action Group members about this, to invite them to participate in a Project Advisory Board (he extended this invitation to all HIF participants, and to the DFID and WHO visitors). He expressed his thanks to all participants in the SPAG meetings and to the Health Information Forum, which had made this research project possible. A new Action Group: Evaluation Action Group Monitoring and evaluation are essential parts of the whole communication process. They are the way that we can determine how effective our message and the medium we are using is in achieving the hoped for result. They help us learn, help us improve, help us and the people we are working with develop. But there are always questions about monitoring and evaluation. Let's explore some of those questions together. The HIF meeting on 18 January is one opportunity, when Barbara Stilwell from WHO and Andrew Chetley from Healthlink Worldwide will share some of the experience their organisations have had in trying to improve the monitoring and evaluation they do. Another opportunity is the development of a monitoring and evaluation action group. Andrew Chetley has agreed to convene such a group, which will start off as an e-mail discussion, and will include some meetings in the new year. If you are interested in taking part, please send an e-mail message to Andrew Chetley: [email protected]. Initial tasks for the action will be: 1. Help plan the 18 Jan 2000 Health Information Forum meeting 2. Identify key questions and issues to discuss (in subsequent action group meetings) and share experience 3. Examine the potential for developing collaborative projects or activities. Please include any further suggestions in your initial e-mail to Andrew Chetley. 2A: Cooperation with WHO (Neil Pakenham-Walsh, INASP-Health) One of the greatest challenges to the 'health information community' is the cooperative development of a coherent cross-sectoral international approach to support activities at national and local levels. (The 'health information community' in this context refers to all individuals and organizations with an interest in improving access to reliable information for healthcare workers in developing and transitional countries.) To meet this challenge, WHO has agreed to enter a formal process of cooperation with HIF. Over the next year, representatives from WHO will be participating in all HIF workshops so we will have a chance to share experience and ideas over a wide range of issues. More specifically, we are forming a special interest group, a 'WHO-HIF Cooperation Group', to create a 'strategic framework' for long-term cooperation. A strategic framework for cooperation between WHO and other organizations is not an idea in isolation. It is the next logical step, and an achievable step, in a productive cooperation that has been evolving over many years. Several organizations here have individually worked with WHO in various projects over the years. And the Health Information Forum itself has been delighted to welcome several professional staff from WHO: Irene Bertrand (WHO Library), guest speaker in September 98; Pat Butler (Head, Office of Publications), guest speaker in January 99; and Lucilda Hunter (former librarian at AFRO) who participated in our end of year review process. And in January 2000 we shall be welcoming another guest speaker from WHO, Barbara Stilwell. To many of us, these meetings have underlined that structured cooperation between WHO and HIF is achievable and would be enormously productive. Thanks to WHO, things have moved quickly over the last 8 weeks. In mid-September, Sarah Clark and Susan Holck invited me at short notice to Geneva. Briefly, the subjects we discussed fell into three main areas: WHO's role in health information; new approaches to health information access; and –most importantly – the potential for WHO and HIF to work together. WHO's role in health information: The World Health Organization is a major health information provider in its own right, both through its publications and its library services, both of which have had substantial links with, and support for, publishing and library services in developing countries. Further, WHO is widely perceived to have a special potential as a coordinator, facilitator, and advocate for 'access to information for healthcare workers' as an issue, working with other health information organizations worldwide to develop and help implement cost-effective strategies. HIF's role in health information: The Health Information Forum is a neutral focal point for the international 'health information community'. Its objective is to improve access to reliable information for healthcare workers in developing and transitional countries by: facilitating contact and sharing of skills and experience; promoting analysis; and undertaking advocacy. Participation is open to all those with an interest, North and South. Its principles include inclusiveness; avoidance of duplication; non-competition with participant activities; neutrality; and transparency. We realized the best way to move forward on these issues was regular dialogue and sharing of experience among WHO and HIF participants, in parallel with the development of a strategic framework for cooperation. With such a framework, everything else would be expected to develop in a more coherent way. What is a 'strategic framework for WHO-HIF cooperation'?A 'strategic framework for cooperation' cannot be looked at in isolation – we first need to look at our long-term objectives. The long-term aim might be assumed to be increased quality of healthcare, which in turn is partly determined by increased application of reliable appropriate information, increased access to reliable information, and ultimately the strength and effectiveness of international, national, and local health information services. The international health information sector has a responsibility to support national and local health information services, as well as to directly improve access to information. The current challenge for the international health information sector is to identify the right things to do and the most cost-effective ways of doing them. How do we do the right things right? – 1) Trial and error? Ad hoc partnerships? Working in isolation? Repeating mistakes?; or – 2) through Monitoring and evaluation? Sharing experience, successes, failures? Working together to identify priorities and gaps? Generating, debating, and testing new approaches? The proposed cooperation between WHO and other health information organizations aims to strengthen path 2, an 'evidence-based approach to improving access to health information' that will:
The proposal is not about creating a new health information project in itself, nor is about forming a consortium. Further, it is intended to be inclusive. All those with an interest are invited to participate. A dedicated WHO-HIF Cooperation Group will be required to steer the process. The WHO-HIF1 meeting will define how the HIF might best be represented in continuity at subsequent WHO-HIF meetings. It is anticipated that the process will require a total of five meetings held at 2-monthly intervals, coinciding with HIF workshops. HIF participants will be consulted at each stage of the process. The current process (subject to change) is proposed to involve the following stages: WHO-HIF 1, November 1999: Objectives and overall process WHO-HIF 2, Jan 2000: Variables, focus, priorities WHO-HIF 3, Mar 2000: What are we doing? Where are the gaps? WHO-HIF 4, May 2000: Refining the framework WHO-HIF 5, July 2000: Applying the framework in practice The baseline framework will be complete by July 2000. Between July and September 2000, a 'post-framework implementation plan' will be developed to clarify mechanisms for the practical application of the framework, and how it might be maintained and developed in the long term. The process will draw on as wide a range of perspectives as possible and will encourage input from the health information community at large, North and South, including healthcare worker representatives, health information workers, and other sectors. Reports of meetings will be circulated among all HIF participants. Input from stakeholders is not only encouraged, it is necessary for the framework to be a valuable tool for the health information committee. An email discussion list is being considered to help with this. The WHO-HIF Cooperation Group meetings will be held on the same day as (or as close as possible to) each respective HIF workshop meeting. This will allow representatives from WHO to spend time and make contacts at general HIF workshops as part of each visit. It will also allow the Cooperation Group to present a brief progress report at each HIF workshop meeting. 2C Comment (Susan Holck, Director, Information Management and Dissemination, World Health Organization) Dr Holck began her presentation by thanking Neil Pakenham-Walsh and indicating that she would be describing her initial ideas about the nature of the envisaged cooperation, which would be discussed more fully on the next day. She noted that WHO had been working with many of the NGOs represented at the meeting, as well as NGOs in the regions and countries. She felt that WHO and the NGOs had common target audiences. With the arrival of the new WHO Director General, Dr Gro Harlem Brundtland, in July 1998, major changes were introduced at WHO. The organization had been reorganized into nine 'clusters'. The reorganization had helped WHO as a whole to take stock of its activities and policies, and work on refining its corporate strategy was underway. One important core function that runs through all clusters is WHO's need to be fully involved in providing reliable and timely information. WHO generates, aggregates, processes, packages and disseminates information. She reminded the audience that the WHO department covering publications, the library and other WHO information areas was in the 'Evidence and Information for Policy' cluster. Thus, information was between 'evidence' and 'policy' – an important concept. There was now a more explicit emphasis on information quality, on ensuring that it was evidence-based, and on the more efficient use of resources. A year ago, a review was carried out of printed media produced by WHO, which identified areas which WHO need to improve, including: developing its information policy/strategy, identifying audiences and their information needs, prioritizing the focus of WHO's 'product', better use of technology, and the need to strengthen partnerships. This latter need prompted WHO to seek out and strengthen its relationship with the Health Information Forum. WHO: —has a global presence with natural links with Ministries of Health in the countries —is not a donor, implementation or training agency —does not have a strong local presence, and was not well suited to work on a community level WHO has much to gain from the proposed WHO-HIF Framework for Partnership. Much more collaboration with NGOs should be possible, as roles are genuinely complementary. She stressed that the framework would be used to develop concrete joint activities – that the end of this Framework would be action together, with resultant increases of efficiency and cost-effectiveness. In the discussion that followed, a number of participants wondered if there were equivalents to HIF elsewhere. The general feeling was that there were not. Some Scandinavian multilaterals had health networks, but these did not focus on information issues. The UK had a particularly strong history of getting NGOs together. If possible, WHO would like to go beyond HIF to other forums if they could be found, and to help promote their formation elsewhere. It was stated that librarians tended to be well organized both nationally and internationally. The agriculture sector also had networks such as Media for Development and Democracy. Peter Bewes noted that half of the hospitals in Uganda were now holding meetings to disseminate information, and that half of the information disseminated came from Uganda's medical doctors. In general there seemed to be increasing activity in information dissemination and sharing. The concept of information as a tool for development was embraced by such initiatives as the World Bank's Global Knowledge programme, although this was more about structure and infrastructure than content. In his closing comments, Richard Smith recognized that the Health Information Forum clearly met a need, as was shown by its steady and growing attendance figures. He noted that the present meeting had focused on abstract, strategic questions, while the usual HIF meeting tended to be grounded in more practical questions. Nevertheless, he felt that it was useful to move between strategy and action from time to time. He thanked all speakers and contributors, and said he would look forward to the results of the first WHO-HIF Framework meeting. Health Information Forum is run as part of the INASP-Health Programme (International Network for the Availability of Scientific Publications), which also provides an advisory and referral service for health information workers and publishes the INASP-Health Directory – a reference and networking tool for organizations working to increase the availability of appropriate, reliable, low-cost information in developing countries and countries in transition. Contact: Neil Pakenham-Walsh, Programme Manager, INASP-Health, 27 Park End St, Oxford, OX1 1HU, UK. Telephone: +44 (0)1865 249909 E-mail: [email protected] WWW: www.inasp.info |
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