Internship report José Miguel Uribe April 2014

PAHO Internship report (JHSPH practicum).

JosĂŠ Miguel Uribe April 23, 2014.

Achievements.

The internship program at the Pan American Health Organization (PAHO) allowed me to better understand how public health research is implemented and adopted as a key component of health promotion and development in the Latin American region. In order to achieve the goal of having and effective health system providing quality of care adapted to local needs, health research is a crucial element. The Research Promotion and Development group at PAHO has undertaken important steps to achieve this goal, and the implementation of the ICTRC, a database for registering clinical trials, is an important component. Finally, the internship at PAHO allowed me to apply the concepts and put in practice skills acquired from the courses of the Master in Public Health program I am currently undertaking at the John Hopkins Bloomberg School of Public Health, and thus fulfill the practicum requirements.

Location and Dates.

Pan American Health Organization, Washington D.C. Headquarters.

Health System and Services Research Promotion and Development Dates: December 2, 2013- March 21, 2014.

Advisors: Luis Gabriel Cuervo, MD, MSc Lic. Eleana Villanueva

Activities: 1. I contributed to the design and translation of the Survey of a tool for measuring the implementation of PAHO’s Policy on Research for Health (CD49/10)i. The tool had been designed and completed by Dr. Cuervo in collaboration with former intern Jimmy Toan Lê. Measuring the implementation of the Policy on Research for Health is a challenging goal. Dr. Cuervo and his team found that the most convenient and feasible way to do it is through a general survey to be responded by knowledgeable actors in each of the member countries. The survey asked to what degree, in the best knowledge of the respondent, had the objectives been achieved in the country.

The six objectives of the Policy were defined and each one was measured through six elements. Importantly, the tool results where planned to be a base level reference for each country and a convenient way to identify the specific areas for improvement in order to implement the policy, and not a “pass/fail” result.

I participated in he final formulation of one of the survey questions and drafted the translation from English to Spanish. In the process, I learned about PAHO’s Policy on Research for Health and its relevance for the region and how good quality health research is needed in order to achieve equity and reduce inequalities in the region, as well as strengthening health systems and capacity building. The ultimate

goal of an evidence-based public health approach needs to grounded on good quality clinical research.

2. I drafted an invitation for experts to comment on the instrument.

3. I had the opportunity to improve translation skills under the direct supervision of Dr. Cuervo and also learned how to design a questionnaire using the survey monkey format thanks to the help of former intern Jimmy Toan Lê.

4. I developed the protocol “Mental health research registered in the ICTRP and its relation to burden of disease and research priorities in Latin American and Caribbean Countries.” The project seeks to characterize mental health research in the Latin American region and its correlation with the priorities of the region, using the ICTRP database of registered clinical trials. The protocol was developed with inputs from Dr. Cuervo and Dr. Reveiz, from PAHO. The protocol is shown in an annex.

5. I participated in a team with other two interns, Dr. Rachel Hutchinson and Dr. Natalia Godoy who also worked on characterization of clinical trials using the same database but addressing different health problems. We developed a common methodology and shared ideas on how to improve the protocol I developed.

6. To implement the protocol I developed a spreadsheet with the main data variables. The data extraction and analysis is now in its final phase and the final report result is pending.

7. I attended the meeting “PAHO Biannual assessment of work - strategic objective final assessment - strategic plan 2008-2013.” The meeting was a high level discussion of the goals achieved across the main public health components of the

organization’s plans and included analyzing existing barriers and ways to overcome them.

8. I organized a presentation for the research interest group (RIG. I invited Dr. Frederico Guanais, health specialist at the Interamerican Development Bank (IDB) to give the presentation of his published paper “The combined effects of the expansion of primary health care and conditional cash transfers on infant mortality in Brazil.ii” The paper received the award ¨Paper of the Year 2013 (Editors Choice)¨ from the American Journal of Public Health in recognition of its innovative design and high relevance.

The meeting had a very good attendance and a lively discussion. As a group, we were able to better understand the concept of cash transfers as it applies to health care and the expansion of the primary health care program in Brazil, which has worldwide recognition. The main finding of the study was the synergistic effect of cash transfers along expansion of primary care access in reducing infant mortality.

The discussion also emphasized the importance of using a multi-sectorial approach in improving health conditions for the most disadvantaged group and reducing health inequalities. The challenges and barriers to implementing this approach in other countries in Latin America were also discussed.

Another important lesson from the RIG was realizing how it is possible to do high quality research and the importance on knowing and using local data. Finally, the paper and the discussion were a good example of the interaction of public health research and evidence-base public health policies.

Final remarks.

Overall, the internship experience of PAHO was a good match with the learning objectives of the MPH program at the Johns Hopkins Bloomberg School of Public Health. The only limitation is not having more time in order to fully engage and learn even more from a leader organization in global health.

PAHO, "Policy on research for health: document CD49/10," in 49th Directing Council, 61st Session of the Regional Committee of WHO for the Americas, Washington, DC, 2009. i

Guanais FC. The combined effects of the expansion of primary health care and conditional cash transfers on infant mortality in Brazil, 1998–2010. Am J Public Health. 2013;103(11):2000–2006. ii