As many anthropological and sociological studies have shown, there are multiple factors contributing to different health-care seeking patterns. Many times, tradicional/ alternative/ complementary medicine is sought precisely because people are not happy with biomedical responses to their situation or considers it more harmful and less effective - depending on the situations - than other approaches to their health problems. And this is not based on 'beliefs', but on their actual experiences.
Undertaking health research
Taking a collective learning research approach could generate more useful insights on this important issue. The fragmentation of practical medical knowledge suggests we can generate more progress by looking at medical knowledge as a nested set rather than as a hierarchy. At the moment, medical practice is researched and presented as competition between modern medical health practices and traditional medical practices, with an expectation for modern medicine to win this 'Olympic' competition.
As governments are developing schemes for universal health coverage (UHC) and progressing towards the sustainable development goals (SDGs), they need relevant and context-sensitive evidence to support different policies and interventions. Decision-makers are increasingly using qualitative evidence to understand various socioeconomic contexts, health systems and communities.
Herbal medicine has been accepted as a component of global health. The current investment going into research and development of herbal products is unprecedented. It is very sad to note that in country like Nigeria where over 80% of her population relies on herbs for daily health needs, only few of such herbs have been validated using research. In a recent study conducted in Ibadan, it was discovered that of the herbal products evaluated, only about 20% of the products were validated using clinical trial. In spite of this, over 80% of the manufacturers made various treatment claims.
In agonising, crippling pain from lung cancer, Mr S came to the palliative care service in Calicut, Kerala, from an adjoining district a couple of hours away by bus. His body language revealed the depth of the suffering. We put Mr S on morphine, among other things. A couple of hours later, he surveyed himself with disbelief. He had neither hoped nor conceived of the possibility that this kind of relief was possible. Mr S returned the next month. Yet, common tragedy befell patient and caregivers in the form of a stock-out of morphine.
The Global Burden of Disease AMR project is a collaboration between the UK government, the UK health research charity the Wellcome Trust, the Bill and Melinda Gates Foundation, the University of Oxford, and the Institute for Health Metrics and Evaluation, an independent research centre at the University of Washington, Seattle.
Over the next four years the project will gather and publish data on the spread and effects of antimicrobial resistance around the world.
Incorporating evidence is fundamental to maintaining the general acceptance and efficiency in public policies. In Pakistan, different actors—local and global—strive to facilitate the development of evidence-informed health policies. Effective involvement however, requires knowledge of the country-context, i.e. knowing the intricacies of how policies are formulated in Pakistan. Obtaining this knowledge is one of the key steps to making interventions impactful.
Implementation research (IR) focuses on understanding how and why interventions produce their effects in a given context. This often requires engaging a broad array of stakeholders at multiple levels of the health system. Whereas a variety of tools and approaches exist to facilitate stakeholder engagement at the national or institutional level, there is a substantial gap in the IR literature about how best to do this at the local or community level.
There are problems with relying mainly on local evidence when the local researh culture is weak, mainly observational, and often not peer reviewed. The whole architecture of reading, writing and publishing is faulty because the demands of 'publish or perish' encourages quantity rather than quality. Scholarship is better when it is global / international in scope and scrutiny. Context is important but before localising content it is even more important that the fundamentals meet international best practice.
Amref Health Africa has developed a mobile app that has in it the Ministry of Health household data collection tools that CHWs are tasked to use. The app works on line and off line allowing CHVs in hard to reach or poor network areas to still collect data. The CHWs can therefore collect data with their own mobile phone and only need to use bundles/ internet connection to allow the data to be transmitted to the DHIS. This has seen a significant improvement in data collection, quality of data and reduced cost of printing data collection tools as well as