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The Case for Research to Promote


									The Case for Research to
Promote Evidence-Based
     Global Health
      Paul Freeman
  Evidence-Based Approach
Widely accepted for clinical care & health
professional driven behavioral programs
World Bank –output based cost effective
interventions - in terms of lives saved

Quality Health Care with proven interventions
District Level – professionals/proven programs
Private Licensed EB Doctors---------BUT
         Current Problems
Scale /Access / Distribution

safe- inexpensive proven care
NOT REACHING -majority population

Cost of “health” care - Empovishing (T.Evans)

Health personnel deficient---non-industrialized
 Health is NOT just Health Care

Health Professionals are not the only
         Health Care givers
How about sickness care?
From 70 – 90% of all sickness care takes
  place in the home*
 Household members, especially mothers:
  – make the primary diagnoses of illnesses
  – assess the severity and likely outcomes
  – select among available providers and treatment
  – procure and administer treatments

         *Source: WHO, World Health Report 2002. Reducing Risks,
         Promoting Healthy Life ---- per Henry Moseley
       What are the health problems in the
     population, and how are they produced?

Source: WHO, World Health Report 2002. Reducing Risks, Promoting Healthy Life
Examples of household action for health

 Unsafe water, sanitation and hygiene –
 collection, storage, utilization of water;
 bathing; washing clothing, bedding,
 utensils; use of soap; hand washing; food
 preparation (incl. infant formula) and
 storage; latrine practices and waste
 disposal; etc.
How about access to and use of
  health service providers?
 Barriers to access and use are not just
physical distance and financial costs but also
relate to household beliefs and practices like:
– Trust and confidence in the provider
– Awareness of morbidities and treatment options (“culture of
– Gender roles and cultural constraints
– Fear - of the unknown, of revealing private matters, etc.
– Information/misinformation about health services and products

Practices   Resources
Per Capita Health Spending in Cambodia




                 Source World Bank 2004
  Need for Evidence-Based
 Research for community level
To help strengthen and make more cost-
effective what household members are
already doing –do they work, ?modify

Better local implementation of currently
proven methods – e.g. breast feeding.

Introduction of “new” approaches at
community level.
Inauguration of Child Friendly Village, ADRA Cambodia August 2006
What Could We Learn About Health from this 90 year old
               Cambodian Couple?

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