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The Case for Research to Promote Evidence-Based Global Health By 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 important 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 options – 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 silence”) – Gender roles and cultural constraints – Fear - of the unknown, of revealing private matters, etc. – Information/misinformation about health services and products Values Practices Resources Per Capita Health Spending in Cambodia $8.0 Houshold Government $2.5 External $24.0 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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