Final Report January 31st, 2008 Agreement # USO 07056472 Development of a Health Research Capacity Building Workshop in Bolivia
TO: Pan American Health Organization/ World Health Organization 525 23rd St. NW Washington, DC CCGHR 58 Arthur Street, Suite 201 Ottawa, ON K1R 7B9 Tel: (613) 783-5115 Fax: (613) 783-5117 www.ccghr.ca ccghr@ccghr.ca
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1. General Information – Canadian Coalition for Global Health Research (CCGHR)
National Coordinator: Mailing Address: Telephone/Fax: Email: Website: Legal Status:
Vic Neufeld, Professor Emeritus, McMaster University 58 Arthur Street, Suite 203, Ottawa, ON Canada K1R 7B9 (613) 783-5115; (613) 783-5117 info@ccghr.ca www.ccghr.ca Incorporated in 2003; Fiscal Year: April to March
In December 2003, the Canadian Coalition for Global Health Research (CCGHR or “the Coalition”) became an “official” not-for-profit organization. Its mission is: ..to promote better and more equitable health worldwide by: • Mobilizing greater Canadian investment (and involvement) in global health research; • Nurturing productive partnerships among Canadians and people from low and middle income countries; • Turning research into action The CCGHR is governed by a volunteer Board. Since May 2004, the CCGHR membership has grown to more than 1000 members, of which 467 are individuals from over 73 low and middle income countries (LMICs). The remaining 533 are Canadians. Members include: • • •
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The research community (active researchers, academic leadership, students, nonuniversity researchers and associations) People actively engaged in applying research to improve global health (healthoriented international development NGOs, professional associations) Representatives of organizations interested in funding health research (overseas development agencies, private research funding agencies, foundations, health research funding agencies, labour and union organizations) Interested members of the media and the general public.
The CCGHR has now embarked upon a number of specific actions to achieve this mission. This is being done through task groups comprised of Coalition members, secretariat staff, and when feasible, selected consultants and advisors. The Task Groups are as follows: 1. 2. 3. 4. 5. 6. 7.
Research to Action Global Health Systems and Policy Research Mobilizing Support Global Indigenous Health Research Strengthening National Health Research Systems Building Equitable and Collaborative North-South Partnerships Capacity Building
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The Coalition works closely with the Global Health Research Initiative (GHRI), a grouping of four federal agencies including CIDA, CIHR, IDRC and Health Canada, that have committed themselves, through a memorandum of understanding (MOU) to work together to achieve a stronger Canadian involvement in global health research. [We understand “global health research” to mean the production and use of knowledge concerning the health problems borne by societies in low and middle income countries (LMICs). The Canadian Coalition for Global Health Research’s (CCGHR) Canada- Bolivia team, with the support of this grant from PAHO, held a five-day workshop entitled “Perfecting the Proposal of Research in Health in Bolivia” in Cochabamba, Bolivia from December 3rd- 7th, 2007. The following reports on the preparation, implementation and outcomes of the workshop and related activities.
2. Phase One: Pre-workshop Preparation A) Invitation and Selection of Participants The Bolivia workshop was organized by the CCGHR’s Canada-Bolivia team, in coordination with key partners in Bolivia. The Canada-Bolivia team is made up of Dr. Jeannie Haggerty and Dr. Andrea Cortinois (Co-Chairs), Maija Kagis, and Jill Murphy (Project Officer). The Coalition’s key partners in Bolivia during the planning period were Dr. Carmen Ledo (Universidad Mayor de San Simon), Tara Bickis (Ministry of Health and Sport) and Dr. German Crespo (Ministry of Health and Sport). The Canada-Bolivia team hoped to reach a wide number of researchers and other stakeholders from across Bolivia and to identify a motivated working group to strengthen the Bolivian National Health Research System (NHRS). The team released a Call for Proposals, which required interested researchers in Bolivia to apply by sending a proposal outlining their interest and experience. The Call for Proposals required that participants be relatively experienced researchers working in diverse areas of health research (biomedical, social, services-based, economic etc). The team aimed to target emerging or recognized leaders who had demonstrated a strong personal commitment to health research and were motivated to contribute to strengthening the NHRS through continued activity in a working group. The Call for Proposals was distributed through the networks of CCGHR contacts in Bolivia and at a Ministry of Health and Sport (MSD) workshop on health research. Despite a wide range of distribution, the Call for Proposals did not result in a sufficient response or in an adequate number of acceptable proposals. The team therefore tapped existing contacts in Bolivia for suggestions and sent invitations to these individuals asking them to respond in the same manner as initial applicants. The Call for Proposals and invitations, along with specific invitations to key institutional actors (such as representatives from the MSD and PAHO) led to 20 Bolivian participants in the workshop. Dr. Jeannie Haggerty, Maija Kagis, Kim Scott and Jill Murphy represented the Canada-Bolivia team in Bolivia. Dr. Andrea Cortinois was unable to attend due to a family emergency.
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Workshop participants came from Cochabamba, La Paz, Sucre, Santa Cruz, Oruro and Tarija. They represented universities, research centres, NGOs, health service centres, the MSD and PAHO. B. Preparation of Workshop Training Materials The Canada-Bolivia team spent three months prior to the workshop preparing the content and materials. The team met in Ottawa at the CCGHR office in September for two days of meetings, during which time they discussed the content and structure of the workshop, as well as some logistical details. The main outcome of this meeting was a clear vision for the workshop and a schedule of sessions across the five days. The team was also able to meet face-to-face during the Canadian Conference on International Health (CCIH) in November, where they held a public meeting on the progress of the team (see Appendix A). Between September and December the team had several planning conference calls. During these calls the team refined the content and structure for the workshop, made decisions regarding participants and discussed logistical details. The team, lead by Jeannie Haggerty, used email and phone correspondence to develop the content of workshop sessions. These included: - Defining National Health Research Systems and giving examples of systems in Canada and other Latin American countries (Jeannie Haggerty, Maija Kagis and Carmen Ledo). - Canadian and international sources of health research funding (Maija Kagis and Jill Murphy). - The peer review process (Jeannie Haggerty). - Research ethics (Jeannie Haggerty and Kim Scott). - A case study of a CIHR funding proposal application process (Jeannie Haggerty). These sessions were complemented by facilitated group discussion and by presentations by external facilitators (see page 6). C. Logistics and Coordination of the Workshop The logistics of the workshop were coordinated by the CCGHR Project Officer and by a local event organizer (Maria Renee Terrazas, Grupo Pretorian). The Project Officer worked in coordination with the local organizer to book a venue, organize travel and transportation for participants, compile and print workshop materials, and organize catering and accommodation arrangements. The CCGHR was extremely pleased with the work of Grupo Pretorian before and during the workshop. The Project Officer also planned team conference calls, corresponded with participants regarding their acceptance and travel to the workshop, compiled workshop materials, coordinated per diems and travel reimbursements for participants and responded to participants’ needs before and during the workshop.
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3. Phase Two: Workshop The CCGHR Canada-Bolivia team decided to hold the workshop in Cochabamba, which facilitated a retreat-style atmosphere. The workshop was held from December 3rd- 7th, 2007. The workshop set out to provide a capacity building opportunity for Bolivian health researchers with sessions on international funding agencies and opportunities, ethics, peer review and international health databases. The workshop also aimed to build on work begun by the MSD on strengthening and institutionalizing a national health research system. The NHRS became the primary focus of the workshop as the result of participant interest. From the first day of the workshop, where the concept of NHRS was introduced and examples were given of such systems in other countries, participants showed a clear interest in capitalizing on the five days together to engage in solid analysis and planning for a Bolivian national health research system. There was keen interest from participants on the capacity building elements as well. National Health Research System Work: Work on the NHRS began by defining national health research systems and by exploring examples of NHRS in Canada, Chile, Ecuador and Uruguay. Participants also discussed the importance of a NHRS in general and for Bolivia in particular. Tara Bickis and German Crespo of the MSD presented their work to date on strengthening the NHRS in Bolivia. This work has involved meetings and workshops with key actors and has laid a crucial foundation for the coordination of the NHRS. Human and financial resources at the MSD are currently limited, but research is a priority of the new government. Efforts are being made to increase the available resources and the MSD has demonstrated its interest in playing an integral role in building the NHRS. Throughout the five day workshop the group worked though an analysis of challenges, threats and opportunities for a Bolivian Health Research System. They began by identifying challenges and threats that they felt were unique to Bolivia. These included: political flux; enabling a system to reach national, municipal and local levels; coordination between the government and the universities; capacity for a coordinating body to govern such a system. Following the identification of these challenges, the results were grouped according to themes. These themes determined breakout groups for the remainder of the week. The themes identified were: finance, governance, human resources and ethics. The participants worked throughout the week to refine statements on challenges and opportunities within these theme areas, to consider how they would “fit� within the proposed NHRS, and eventually to propose action and next steps for each area within a system. In discussions on the NHRS in Bolivia, participants agreed that a system does already exist in the country, but that it lacks coordination and infrastructure. Participants also agreed on the importance of creating a well-governed and sustainable system to support
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multidisciplinary health research that responds to Bolivian priorities. A number of gaps were identified during discussions, including the lack of mechanisms for knowledge management and knowledge translation. Participants also identified gaps in institutional support, as universities tend to prioritize teaching above research and many researchers must conduct their research on their own time. They also called attention to the lack of Bolivian sources of funding for researchers and research. Capacity Strengthening Work Although the workshop’s primary focus was on strengthening the NHRS, there were clear accomplishments and interest in capacity strengthening for applications to international health research funding. The participants displayed significant interest in sessions on Canadian and international funding opportunities, peer review processes and case studies of funding proposals to specific agencies. Other topics crosscut the capacity building and NHRS pieces, including ethics (particularly for work with indigenous peoples), knowledge management and the importance of databases of research and researchers. Members of the Canada-Bolivia team facilitated a number of sessions of capacity strengthening for international funding proposals (see page 4). Additionally, Susana Hanover of PAHO-Bolivia presented on knowledge management and database systems. In addition to teaching participants about the availability of several knowledge databases (SCIENti, LILACS, DeCS, etc.) she discussed existing Bolivian journals and the challenges faced for publication in Bolivia. Hanover also discussed with participants the importance of establishing a database of Bolivian health researchers. Indigenous Health Kim Scott, from the CCGHR’s Global Indigenous Task Group, accompanied the CanadaBolivia team to Cochabamba through a grant from CIHR’s Institute for Aboriginal Peoples’ Health. As the focus of the workshop was on capacity strengthening and strengthening a NHRS, Scott largely played the role of an observer, seeking to understand the extent to which indigenous health research was prioritized in Bolivia. She was also interested in understanding the degree to which Bolivians “self-identified” as Indigenous people. The original intention was to use Indigenous peoples’ health as an entry point for the implementation of the workshop. This, however, was a challenge in practice. While some 60% of the Bolivian population is identified as “Indigenous”, the CCGHR found it challenging to identify Bolivian researchers doing work that explicitly relates to indigenous health as it may be identified in the Canadian context. While many may work with Indigenous populations, they do not seem to identify themselves either as Indigenous researchers or as researchers of indigenous health. Additionally, the process of determining who would participate in the workshop did not allow for the team to target Indigenous health researchers in particular. Researchers came from a number of disciplines within the health field. It was therefore decided that Kim Scott would accompany the team in an observer capacity to help the CCGHR better understand the Bolivian context and to make recommendations for the future work of both the Bolivia-Canada team and the Global Indigenous Task Group. This includes planning for the CCGHR’s Fifth Summer Institute for New Global Health Researchers, which will focus on Indigenous peoples’ health.
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Scott attended all workshop sessions, held small group and individual interviews regarding indigenous health and indigenous identity in Bolivia, and supported the session on research ethics. (See Appendix B for Kim Scott’s report). The CCGHR will continue to explore ways in which Canada and Bolivia can work together on indigenous health.
4. Phase Three: Preparing a Project A. Strategic Meeting between CCGHR and Bolivian partners to discuss longer term plans for NHRS strengthening On the last afternoon of the workshop, a “strategic meeting” was held. This involved workshop participants and additional actors invited from the Universidad Mayor de San Simon in Cochabamba, NGOs, PAHO, the Canadian International Development Agency (CIDA) and the MSD. The CCGHR and local partners hosted a lunch for meeting invitees and proceeded with a presentation of the results of the workshop. Dr. Jeannie Haggerty and Dr. Javier Luna Orosco presented a draft of a declaration on the NHRS, which was then circulated and signed by all meeting participants (see Appendix C). As is evidenced by the signing of the declaration, meeting participants responded favorably to the workshop results, acknowledging the need to move forward on strengthening the Bolivian NHRS and demonstrating their commitment to the process. In the week following the workshop CCGHR representatives also held strategic meetings in La Paz and Santa Cruz (see below). Overall Outcomes The workshop and subsequent meetings were very productive and a number of outcomes can be identified: -
The development of a proposal for the structure of the NHRS. o The proposal includes a National Council on Health Research (CONAIS), which will be composed of representatives from various areas including government, universities and civil society. The CONAIS will work in coordination with a sub-unit of Health Research in the MSD and with provincial health research bodies. The CONAIS will contain three subcommittees: Ethics; Finance, Resource Mobilization and Human Resources; and Analysis, Diffusion and Application of Knowledge (see Appendix D for the complete NHRS proposal). o The workshop participants agreed that the first steps for the NHRS would be a Bolivian-launched competitive call for health research proposals and the establishment of an ad hoc committee that will begin work on establishing policies and procedures for the NHRS.
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A working group on the NHRS. During the workshop a clear group of actors emerged as a working group (grupo impulsor) for the NHRS. This includes representatives from universities, the MSD, research organizations and donor agencies. Key actors include Dr. Carmen Ledo (Universidad Mayor de San Simon), Dr. Javier Luna Orosco (MSD and National Bioethics Committee), Dr. Sara Perez (Universidad Mayor de San Andres), Dr. Lorena Soleto (Centre for Tropical Diseases, Santa Cruz) and Dr. Carlos Erostegui (Universidad Mayor de San Simon). Other important actors include Tara Bickis and Dr. German Crespo of the MSD and Dr. Christian Darras and Susana Hanover of PAHO Bolivia. The CCGHR is also currently supporting Dr. Carmen Ledo’s application to the Global Health Research Initiative’s Leadership Awards program, so as to help her to continue her work as a national leader and resource person for the NHRS.
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A timeline for 2008 for the implementation of the NHRS proposal. This will largely be implemented from within the MSD and involves: the establishment of priority areas for health research; identification of key regional actors; the creation of the ad-hoc committee and sub-committees; the launch of the competitive fund for research; and a national conference on health research (see Appendix E).
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A declaration on the NHRS. This resulted from the presentation of the proposal and timeline to key actors at the strategic meeting. The declaration was signed by all people present at the meeting and outlines the commitment of those involved to move forward with the NHRS proposal (see Appendix C).
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An electronic forum for the workshop participants and other key actors. An electronic forum has been established to allow easy and accessible communication between workshop participants.
Following the Cochabamba workshop, the CCGHR delegation and participants from the workshop presented the proposal, timeline and declaration to key actors in their department (province). In La Paz this included presentations for the MSD, Spanish and French cooperants, PAHO, CIDA and to approximately 20 health researchers at the Universidad Mayor de San Andres in La Paz. All partners received the proposal very positively and are interested in taking part in, or providing support to, the NHRS. In Santa Cruz a similar meeting was held with local researchers to inform them of the outcomes of the Cochabamba workshop. The meeting also served as the first step towards the formation of a Provincial Council on Health Research. Participants in Santa Cruz made recommendations regarding the NHRS, including the active participation of regional representatives, attention to the issue of intellectual property when working with indigenous populations, and the integration of student research with national priorities and themes.
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B. Dialogue with EVIPNet partners including Bolivian representatives who attended the July 2007 launch of EVIPNet Latin America in Washington. During the Cochabamba workshop, a session was dedicated to the discussion of EVIPNet, with particular attention to Bolivia’s participation. Dr. Javier Luna Orosco attended the July 2007 launch of EVIPNet Americas in Washington and presented the concept of the network and details of the launch to the workshop participants. Many participants were previously unaware of EVIPNet and all displayed great interest in the opportunity. Many workshop participants discussed the challenges of knowledge translation throughout the workshop and were very excited by the opportunity to be part of a network that provides support for evidence informed policy. During the session on EVIPNet, Tara Bickis (MSD) and Dr. Luna Orosco described the proposal they had prepared for Bolivia’s participation in EVIPNet. Although there were some delays in the signing process for the proposal, during the workshop it was officially submitted and is currently waiting for review. C. Support to workshop participants before and throughout the workshop in developing a research project. The nature of the final objective of the workshop was somewhat altered due to the interest by workshop participants on planning for a NHRS in Bolivia and due to the decision to recruit experiences researchers from diverse disciplines. As described above, the workshop involved sessions on capacity strengthening for applications to international research funding sources, including a case study of a specific research proposal. The workshop did not however focus on building a specific research project, but rather emphasized planning towards the strengthening of a NHRS. Workshop organizers felt that this process is crucial for Bolivia and that it is a process for which the CCGHR could continue to provide support and capacity building opportunities through its Canada-Bolivia country focus team. The CCGHR has a Task Group on Strengthening National Health Research Systems, which is supporting similar work, through similar country focus teams, in Zambia, Mali and Mongolia. The proposal for work on the NHRS in Bolivia, described above and supplemented in the appendices, can be seen as a “project”, although focused on institutionalizing health research that is locally supported and responds to Bolivian priorities, rather than on one specific research question. The CCGHR feels that this work is incredibly valuable and that this grant was instrumental to creating the environment necessary to bring together a working group that will lead this process. The Cochabamba workshop was very successful, with significant commitment to the strengthening of a Bolivian NHRS from researchers, government officials, representatives of international organizations and civil society. There are many steps to be taken to ensure that the NHRS becomes a sustainable, well-coordinated body that fully supports Bolivian research on national health priorities. The MSD will play a key role in moving this goal forward, as will the members of the CONAIS. Although the motivated and committed participants at the workshop will volunteer their time, they will require support from their
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institutions in order to succeed. Similarly, the MSD and the CONAIS will require financial and other support from external bodies in order to succeed with the NHRS. The Coalition will explore opportunities through which we can best support Bolivia in this next phase of NHRS development.
5. Acknowledgements On behalf of the Board, staff and membership of CCGHR, we would like to express our sincere gratitude for this continued commitment that has allowed us to carry on the very important activities described in this report. PAHO’s support is acknowledged on the CCGHR website (Canada-Bolivia Country Focus Strategy Team Meeting Report) and will be acknowledged in the upcoming Country Focus section of the website. PAHO will also be acknowledged in the spring 2008 edition of CONNECTIONS. Further thanks will be expressed in the Annual Report 2007-08 and the audited financial year-end statement (available in May 2008).
6. Attachments The following documents can be found in the appendices: Appendix A, Page 11: Canada-Bolivia Country Focus Team Meeting Report Appendix B, Page 14: Kim Scott’s report on CCGHR’s indigenous health work Appendix C, Page 18: Workshop “Tolavi” Declaration (Spanish) Appendix D, Page 21: NHRS Proposal (Spanish) Appendix E, Page 31: Timeline for first year of NHRS (Spanish) Appendix F, Page 32: Workshop Participants List
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Appendix A
Canada- Bolivia Country Focus Strategy Team Meeting Report The annual open meeting of the Canadian Coalition for Global Health Research’s (CCGHR) Canada-Bolivia Country Focus Strategy Team took place on November 6th, 2007 during the Canadian Conference on International Health in Ottawa. The purpose of the meeting was to bring together the CCGHR’s Canada- Bolivia team, colleagues who are interested in collaborating in order to strengthen a national health research system in Bolivia, and individuals who have worked with national health research system strengthening elsewhere. Specifically, the meeting was intended to: -
Introduce the CCGHR’s vision for strengthening national health research systems; Introduce the work of the CCGHR’s Canada- Bolivia team and discuss next steps, and; Allow for networking and collaboration between workshop participants.
A number of individual invitations were sent to key actors prior to the meeting. It was also listed in the conference program and the team was very pleased when several new people joined the session out of interest. Instrumental in the meeting were three Bolivian partners: Dr. Carmen Ledo from the University of San Simon in Cochabamba who has since become a key actor in the work towards national health research system strengthening; Dr. Alberto Gimenez from the University of San Andres in La Paz; and Herland Tejerina, health consultant for CIDA in Bolivia. In attendance were key Canadian actors from Health Canada, Pan American Health Organization (PAHO), and a number of universities and non-governmental organizations. Also present was Dr. Joseph Kasonde, a key partner in the CCGHR’s Zambia- Canada Country Focus Team (see below for a complete list of participants). Andrea Cortinois, Co-Chair of the Canada-Bolivia Team, chaired the meeting. Ken Bassett, Chair of the CCGHR Task Group on Strengthening National Health Research Systems (SNHRS) provided an introduction to the work of the country focus teams in general and to the overall CCGHR experience with SNHRS, including the work in Zambia. Co-Chairs Andrea Cortinois and Jeannie Haggerty provided an outline of the team’s work, and described the process of a call for proposals that was made for the
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CCGHR workshop (held from December 3rd- 7th, 2007 in Bolivia). This led to a discussion not only of the planned workshop but also of the nature of research collaboration and coordination in Bolivia, of political opportunities and barriers to research, and of funding agency requirements and recommendations. Nathan Souza, McMaster University PhD Candidate and former intern with PAHO, made a presentation on the World Health Organization’s Evidence Informed Policy Network (EVIPnet) launch in the Americas and its implications for Bolivia. He described EVIPnet’s mandate with particular attention to the Latin American region. Following the EVIPnet presentation Dr. Vic Neufeld, CCGHR’s National Coordinator, led a discussion of future steps and the CCGHR’s role in Bolivia.
The meeting was very productive and had several important outcomes: -
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Twenty people participated in this meeting, a number of them “new faces” to the CCGHR. We were very pleased with this attendance as it indicated a large show of support and interest in the Canada- Bolivia initiative and an opportunity for new connections and networking among participants. We presented the plan for the Bolivia workshop, then in the planning stage. The workshop was funded by PAHO’s Biennial Programming Budget fund and we were lucky to have two representatives from PAHO present. They and other meeting participants made recommendations of ways in which to strengthen the workshop, and to build important connections with researchers and policy makers in the country. The presence of several actors with experience in SNHRS in other countries led to interesting discussions of cross-cutting issues such as: health research system policy and political instability; knowledge translation and research to action strategies; communication and partnership strengthening. This discussion touched both on the specifics of Bolivia and on other countries’ experiences, allowing for important first steps in learning and networking between CCGHR partners. The team, along with Bolivian representatives, was able to discuss our work, both generally and specifically, with a number of actors and to receive crucial feedback on the Canada-Bolivia initiative. This was essential for gaining support, making new connections and obtaining comments and recommendations on content.
List of Participants: Vic Neufeld
CCGHR, National Coordinator
Andrea Cortinois
CCGHR, Co-Chair Canada-Bolivia Team/ University of Toronto
Jeannie Haggerty
CCGHR, Co-Chair Canada-Bolivia Team/ University of Sherbrooke
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Maija Kagis
CCGHR, Canada-Bolivia Team
Jill Murphy
CCGHR Project Officer
Chantal Robillard
Douglas Mental Health Institute- McGill
Adrienne Wiebe
Aboriginal Health Program, Capital Health, Edmonton
Colleen Davison
CCGHR/ University of Ottawa
Craig Janes
Faculty of Health Sciences, Simon Fraser University
Monica Riutort
University of Toronto
Kate Dickson
Health Canada, International Affairs Americas
Joseph Kasonde
Zambia Forum for Health Research, Zambia
Deloris Russell
Canadian Nursing Association
Marie- Claude Lavoie
Pan American Health Organization
Nathan Souza
McMaster University
Herland Tejerina
Health Systems Consultant- CIDA Bolivia
Koasar Afsana
CCGHR, Co-Chair Building Partnerships Task Group/ BRAC Bangladesh
Peter Berti
Health Bridge
Carmen Ledo
Universidad Mayor de San Simon, Bolivia
Ian Haggerty
University of Sherbrooke
Alberto Gimenez
Universidad Mayor de San Andres, Bolivia
Kim Scott
CCGHR, Facilitator Global Indigenous Task Group
Harriet Kuhnlein
CCGHR, Chair Global Indigenous Task Group, McGill University
Ken Bassett
CCGHR, Chair Strengthening National Health Research Systems Task Group/ Simon Fraser University
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Appendix B
Memo To: CB team, Roberta Lloyd, Harriet Kuhnlein, Jeff Reading From: Kim Scott Date: December 12, 2007 Re: Canada/Bolivia – an Indigenous lens The information gathered here is heavily reliant upon the Bolivian team attending this meeting. It is not the truth. It is merely a set of observations and musings, an Indigenous lens upon health research and Indigenous peoples in Bolivia. Indigeneity in the Bolivian psyche It was difficult to discern if the relative absence of reference to Indigenous peoples was because they form a majority and are inextricably bound to “Bolivian identity� or because they really do not form part of the collective consciousness. For example, in Canada, we would not talk about EuroChristians as a group because they feature prominently in the institutional fabric of the country and everyone associates Canada with this majority. Without clarity on this point, it is difficult to offer commentary on the extent to which Canada is relating to Bolivians as an Indigenous majority or as gatekeepers to an Indigenous majority. While some suggested that half of the participants at the meeting would identify as Indigenous, others were certain that only a couple or three would do so but conceded that many would consider themselves Mestizo, a term historically associated with a more desirable social status than Indigenous. Recent census estimates would identify roughly 60% of the Bolivian population as Indigenous but without a category for Mestizo, this estimate may miss a substantial portion of the population (an additional 30%) who would acknowledge Indigenous roots. As in Canada, self-identification is heavily reliant upon purpose of identification. With recent land distribution policies for indigenous peoples of course many are coming forth and claiming Indigenous identity that might be cloaked in more stigmatizing situations. Similarly, many who did not identify as Indigenous before Evo Morales are now proudly and boldly asserting an Indigenous self (including high ranking public servants). So it appears, at least for the moment, that there is an acceptance, perhaps even a popularity or fashion statement to being recognized as Indigenous. More formally, systems of identification are intimately tied with language use
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which might explain why few at the meeting would identify as Indigenous yet they would certainly appear Indigenous or at least of Indigenous ancestry. Recognized as an imperfect variable upon which to measure identity, the strength of daily language use is nonetheless a very useful tool in determining who really understands the culture. In Bolivia, there are three categories of formal identification including: 1. 2. 3.
Use of an Indigenous language on a daily basis; Your mother tongue is an Indigenous language; or You self identify as Indigenous.
At last, the discourse around being Indigenous is far different from Canada. There remains a postcolonial victim mentality that is pervasive in the Canadian context that is not immediately apparent here but I had limited contact with Indigenous community. The Long and Winding Road of “Decolonization” Decolonization refers both to the movement away from the historical north/south relationships and the liberation of the poor from the rich within Bolivia. As late as the 1950’s, Indigenous peoples were enslaved by the social elite and while “liberation” could be framed as emancipation of Indigenous peoples from colonial and foreign interests, it is not spoken of this way. The popular discourse in Bolivia is very concentrated on both forms of decolonization, probably because the nature of the relationship is essentially the same. I couldn’t help but consider the value of the community freezer model of resource distribution used by an Inuit community in northern Quebec. After the hunt, the freezer is filled and kept in a communal location where families can take what they need without asking or recording. The freezer gets filled and emptied, no one is valorized, no one looses dignity and no one dictates if the caribou gets baked or fricasseed. Seems ideal for a north/south relationship. In any case, Bolivians believe that there is a transformation within their government into something much less colonial and much more Indigenous, even if Aymaran dominated. On first glance, it may appear that the Bolivian government as been ‘indigenized’. Indigenization in Canada is a famous tool that dresses up programs, initiatives and policies with brown faces, a medicine wheel and a few feathers while the essence of the action remains Euro-centric. But, the Bolivian government is engaged in a process of constitutional change that recognizes and respects Indigenous rights. In fact, I was intrigued by the relative absence of Indigenous victimization in the discourse that leaves more time and energy spent on how they will mobilize and influence public policy. When examining research as a microcosm of the decolonization process, some interesting findings were secured. 15
Ethical Considerations Not all universities have ethics review committees and allegedly there is much conflict of interest within the university system. There are however published principles to guide research and many members of the research community conduct themselves and their research ethically and engage with community in a participatory way. Nonetheless, joint efforts between community and researchers are not common and in some cases informed consent is even called into question. There are a variety of national Indigenous political organizations organized by culture that derive their legitimacy from the grassroots giving them much greater autonomy and power than their state supported Canadian counterparts. Indigenous peoples also gain voice and power through a variety of means including unions and other groups mobilized for social action. Internal moral authorities exist at the community level (i.e., manifestations of traditional governance structures that ideally have equal gender representation), but sometimes they follow a patriarchal model where the concerns of women are not always honoured. Still, despite this variety of cultural or collective organizations that ‘represent’ Indigenous groups and the undercurrent of Indigenous power in Bolivia, it is not clear that they are consistently involved in providing collective consent for research on communally endowed knowledge such as traditional medicine/healing. It is clear that some experience has been laid regarding community consent that may be more IDRC driven than related to a standard protocol used by the research community in its relationship with Indigenous peoples. Although more nuclear internal moral authorities could be approached for collective consent, their legitimacy within a university system is unclear. In some cases, research with traditional medicines is limited more by foreign patents than by the intellectual property rights of Bolivia’s Indigenous peoples. There currently does not appear to be a system where Indigenous groups can generate and act upon research questions and the gathered participants admit that they struggle to enroll Indigenous groups in an ideal level of participation. If such collaborations exist, they exist between enlightened and singular investigators who may have established a community relationship. In select circumstances, depending upon who is doing the research, would the investigator partner with the community to agree upon the goals, objectives, and methods of the research as well as interpretation of the data prior to publication and dissemination. Because there is very little funding save for support from international organizations, there also are no partnerships established with community during the research proposal phase. With the recent diversion of hydro-carbon tax to research efforts, there may be opportunity, albeit limited for this to unfold. 16
Adherence to confidentiality appears strong and although there is a system of community based health centres and ‘outposts’, the extent of local access and ownership of primary and aggregated data is definitely not clear. Indigenous methodology was not even addressed because it just seemed such a remote possibility, although in hindsight, this was a mistake. Mutual benefit is likely dependent upon the principal investigators intent and conduct. Within the academic community present, there was a palpable respect for diversity, however, researchers are consistently challenged by intercultural communications making informed consent difficult. Intercultural communications also affect how the research is conducted and the utility of results for the community. It is not clear if or when Indigenous peoples are employed by research efforts or if capacity building forms part of the research effort. Disclosure regarding the amount, source and use of all resources is not clear and monitoring of the research process and the relationship between the community and researcher are also not clear. Assuming Canada is relating to Bolivians as Indigenous peoples, the nature of exchange between Canada and Bolivia appears to include information sharing (i.e., one way sharing of information to raise awareness but cannot, by itself, influence decision-making) consultation (i.e., two-way communication between parties where each can provide feedback) and partnership (i.e., where Canada and Bolivia share power) It is clear that the relationship has defined clear outcomes and a realistic workplan that is simple, time-limited and task-oriented and where outputs form a framework of responsibility and accountability although all roles are not entirely clear. Because this is a resource poor exercise relying heavily upon the earnest intentions of a largely volunteer work force, I suspect that the relationship itself will not be reviewed periodically. We appear to have established informal and formal communication networks at all levels: communication appears open and clear. Of course, there are external factors that affect the process and outcome of the relationship (e.g. political or social environments that might cause instability in Bolivia) but the exchange appears reasonably free from culture and language barriers. There is a history of positive relationship within the group and no one appears engaged under pressure. There is recognition that the development of a health research system will require interdependence and there appears to be positive clarity about the decision-making processes. The roles and boundaries of each party are known and understood and each party is recognized as having something of value to contribute. Although the relationship does not have formal status, sufficient time has been invested to develop it. Everybody’s contribution is recognized and valued, but the degree of Bolivian ownership of the relationship remains unclear and there is a 17
possibility that it may be dependent for its success upon the unique skills of individuals. Sufficient trust exists to encourage risk-taking but it is not clear if the commitment to the relationship is sufficiently robust to withstand most threats. Bolivians appear open to possibility and there is a willingness to work informally and formally with Canada and each other. There is an obvious and clear, shared vision, values, principles and clearly defined joint strategic objectives that are realistic. Each party appears willing to invest time and resources for the long term but without internal Bolivian champions that are supported by Canada, it is unclear how the plan will unfold. The notion of a national health research system has been at the ‘idea’ stage for over thirty years. Without structure, it may remain a conversation of ideas. If Canada is not relating to Bolivia as an essentially Indigenous group, then there is a gatekeeping filter between Canada and the Indigenous majority.
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Appendix C
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Appendix D
PERFECCIONANDO LA PROPUESTA DE INVESTIGACIÓN EN SALUD PARA BOLIVIA Cochabamba, 3-7 de diciembre de 2007 Definición El sistema nacional de investigación en salud (SINAIS) es el conjunto de instituciones académicas asistenciales y sociales que producen y aplican el conocimiento para el mejoramiento de salud y bienestar humano. El ente coordinador fomenta y regula el proceso de producción y aplicación en el país de nuevos conocimientos de alta calidad científica y ética, y se relaciona con otras instancias de desarrollo social. Coordincion y Gobernanza Desafíos: • • • • • •
Falta de estabilidad en políticas de salud a nivel nacional impidan la implementación de un sistema de investigación Necesidad de convencer a la gente pesimista o desilusionada Comprometer a los actores a nivel nacional, departamental, municipal. Necesidad de unir fuerzas, estrategias, y conocimientos para solucionar los problemas prioritarios del país La necesidad de coordinar con los diferentes componentes del sector salud Institucionalizar un ente coordinador que estructure las normas y procedimientos del SINAIS • Necesidad de establecer una estructura de gobernanza neutral y transparente • Necesidad de establecer políticas de investigación dentro de un proceso continuo y sostenible • Lograr que el sistema funcione en todos los niveles (nacional, departamental, municipal y local) • Necesidad de integrar a múltiples actores en el SINAIS (académico, públicos, privados, ONG, comunidad) • Necesidad de legitimar el SINAIS a nivel nacional, regional, local y con diferentes actores • Sistema estructurado, articulado y ejecutado respetando los diferentes niveles de gestión y operación.
Amenazas: • Sistema gubernamental con enfoque centralizado • Amenaza de no respetar la libertad académica de investigación o La amenaza de ingerencia política en las agendas de investigación 21
• •
o Amenaza de intereses particulares que desgastan recursos humanos, tiempo, y dinero haciendo investigaciones interesadas (agenda internacional, nacional) La falta de un sistema único de salud Las amenazas no ser autorizadas, no poder ser realizadas cambiadas en su texto, no son tratados en los despachos.
Oportunidades y Fortalezas • Voluntad política explicita del MSD para implementación un SINAIS • Existe una masa crítica como base para desarrollar el SINAIS • Contexto legislativo ley de participación popular ley de descentralización que favorita la participación social en todo el proceso de investigación y en la definición de la ética de investigación • Ubicar la investigación en salud dentro del sistema general de investigación • Posibilidad de integrar instituciones, organizaciones para efectuar investigaciones en salud • Mejorar la calidad de servicios; por lo tanto permite mejorar la calidad de vida (oportunidad) Vision de la Rectoría del SINAIS Se habrá logrado el éxito en cuanto a coordinación de la investigación en salud cuando el sistema nacional de investigación este conformado por entes normativos y operativos que trabajen con un objetivo común que nace de la identificación de los problemas de salud de la comunidad, y desarrolle el proceso de investigación a nivel nacional basado en prioridades del país. PRINCIPIOS y VALORES QUE ORIENTAN LA ESTRUCTURA Y EL FUNCIONAMIENTO DEL SINAIS • Libertad académica • Independencia política • Ética • Calidad científica • Representatividad Nacional • Participación Comunitaria • Soberanía y Identidad • Transdisciplinaridad y Intersectorialidad • Transparencia • Equidad • Solidaridad Acciones concretas a corto plazo Inmediato: Formar un comité ad hoc para impulsar el establecimiento de las estructuras y procesos del sistema de investigación Sub-comité de financiamiento y movilización de recursos Sub-comité de ética Sub-comité de agenda de investigación y aplicación de conocimientos
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Sub-comité de recursos humanos (¿?) Formar un Consejo Nacional de Investigación en salud (CONAIS) • Formado por representantes de: Ministerio de Salud y Deportes, Universidades, Institutos de investigación, ONGs, organizaciones sociales, etc. • Participación por representantes es esperada como parte de sus funciones pero de naturaleza voluntariado • Funciona para dar orientaciones políticas y dar pautas • En función regular se reúne 2 veces por año Formar una sub-unidad de Investigación dentro del Ministerio de Salud y Deportes • Depende del presupuesto del MSD pero funcionalmente depende del CONAIS. • Es liderado por un profesional creíble y competente con reconocimiento en su campo de investigación • Formar sub-comités de: Ética, Financiero y Recursos Humanos, Establecimiento de prioridades y Aplicación de conocimientos. A mediano plazo: Creación de Consejos Departamentales de Investigación en Salud (CODEIS)
SINAIS
Subunidad de Investigacion de Ministerio de Salud
Ética
CONACy T Consejo Nacional de Investigación en salud
Comité consultante
Consejos Dptal. de Inv. en Salud
Financiamiento y movilización de recursos, y recursos humanos
Analisis, difusion, uso y aplicación de conocimento
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SUBCOMITE DE FINANANCIAMIENTO Y MOBILIZACIÓN DE RECURSOS Desafío de cantidad y perennidad de recursos financieros: • Necesidad de establecer un fondo estable para financiar la investigación operativa y el desarrollo de capacidades • Necesidad de establecer procesos transparentes, transdisciplinarias y participativas de asignación de financiamiento • Necesidad de un compromiso por el estado para financiar la investigación en salud Amenazas • Dependencia de la cooperación externa • Cambio de gobierno y políticas de apoyo a la investigación en salud. • Pequeña comunidad de investigadores para asegurar una revisión por pares objetivo y sin conflicto de interés. Oportunidades • El SINAIS puede apalancar fondo financieros de diversos donantes que permiten crear el sistema de investigación integral y holístico (nacionales, internacional, privados y otros). • Utilización de fondo de IDH para investigación en salud. • Voluntad explicita de la Cooperación externa para apoyar al SINAIS (Francia Bélgica, Suecia, Suiza, Canadá). Visión de la perennidad de financiamiento del SINAIS El SINAIS habrá logrado sostenibilidad financiera cuando se haya asegurado asignación presupuestaria del estado, de la cooperación internacional y de fuentes privados para el funcionamiento del ente coordinador del SINAIS y el financiamiento de generación y aplicación de conocimientos y del desarrollo de capacidades que refuerce la soberanía nacional Acciones concretas a corto plazo Inmediato: Conformar un subcomité ad hoc de finanzas y movilización de recursos • Reunir un fondo inicial concursable • Llamar una convocatoria nacional para investigaciones • Definir los procesos de asignación de fondos (revisión por pares, aprobación ética) A corto plazo: Conformar el subcomité de financiamiento y movilización de recursos dentro de la Sub-unidad de investigación en salud del MSD. • Lograr el marco regulatorio pertinente para asegurar la sostenibilidad economica tanto del presupuesto del estado como de la cooperación internacional. • Gestionar y Operativizar procesos de revisión de protocolos de investigación en salud y asignación de fondos concursables. • Establecer pautas y proporciones de fondos dirigido a diferentes áreas:
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o Financiamiento operacional de proyectos de investigación (biomédico, clínico, epidemiológico y social, sistemas y políticas de salud) Propuestos provenientes de investigadores Propuestas respondiendo a temas prioritarios o Financiamiento de Capacitación de recursos humanos (becas y apoyo salarial para investigadores, ver recursos humanos) o Financiamiento de infraestructura y equipamiento.
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SUBCOMITE DE ANALISIS DE NECESIDADES, DIFUSION, USO Y APLICACIÓN DE CONOCIMIENTO Desafios • Necesidad de enfocar los recursos disponibles a los problemas prioritarios del país. • Incorporación de todos los saberes en los diagnósticos de salud • Necesidad de Implementar de políticas basadas en resultados de investigaciones. • Necesidad de generar conocimiento que permitan cambiar realidades. • Necesidad de divulgar conocimiento practico, accesible, y capáz de impactar, generando cambios. • Lograr que las autoridades nacionales prioricen las investigaciones como insumo del desarrollo. • Necesidad de incentivar el desarrollo de capacidades a tesistas con becas pagadas por el estado en pre y post grado (hablantes de lenguas nativas). • Incorporación de la etno-epidemiologia en los estudios epidemiologos. • Necesidad de aplicar y generar conocimientos para dar solución a los problemas de salud de la población Amenazas • Capacidad del sistema nacional de información de generar datos válidos y fiables sobre los problemas de salud • Financiamiento externo de investigaciones que responden a agendas externas a las prioridades nacionales • Falta de registro nacional de estudios e investigadores • Falta de registro de documentación y otros medios de comunicación nacional (sub-utilización de la biblioteca virtual de salud pública) • Sub-utilización de recursos electrónicos de información (HINARI, Scielo) • Poca productividad en revistas de reconocimiento internacional • Falta de indexación de revistas nacionales de salud por problemas de perennidad, artículos originales, y calidad de escritura científica • Falta de rigor editorial o revisión por pares • Poca cultura y experiencia de escritura científica Oportunidades • Inicio de un proceso de identificación de necesidades prioritarias en el MSD • Fuerte sensibilidad política a la problemática de pueblos originarios • Valoración y gran cantidad de la producción escrita en la universidad y en la sociedad • Acceso a bibliotecas con inscripción a los servicios de HINARI • Acceso fácil a inscripción de investigadores por medio de SciEnti. • Posibilidad de ser país miembro del Evipnet (gozar de 4 años de apoyo y acceso a la información.)
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Visión para el análisis de necesidades, difusión, uso y aplicación de conocimiento El SINAIS habrá logrado el análisis de necesidades, difusión, uso y aplicación de conocimiento cuando haya una demanda por parte de decidores y el público para hallazgos de la investigación para orientar sus decisiones y que la comunidad de investigadores se involucre en labores efectivas de gestión y abogacía para promover la implementación de política e iniciativas basados en hallazgos de investigación Acciones concretas a corto plazo Inmediato: conformar un sub-comité ad hoc de anális de necesidades, difusión, uso y aplicación de conocimiento • Dar asesoría y apoyo a la MSD-Planificación en la priorización de la agenda nacional de investigación en salud • Asegurar la participación de Bolivia en Evipnet y su difusión en la comunidad de investigadores y decidores A corto plazo: Conformar el subcomité de anális de necesidades, difusión, uso y aplicación de conocimiento dentro de la Sub-unidad de investigación en salud del MSD. • Hacer vínculos con otros actores para asegurar la capacitación y el perfeccionamiento profesional de recurso humano en la producción científica y académica. • Fortalecer el registro y análisis de la producción científica y técnica. • Fortalecer el desarrollo de redes de conocimiento (BVS, Scielo, Scienti, Cochrane, EVIPnet, y otros.) • Fortalecer y fomentar la utilización de medios de difusión científica. • Promover el uso de nuevas intervenciones y tecnología para el beneficio de salud en el sistema nacional de salud. • Establecer pautas para la difusión y uso de resultados de las investigaciones por medios oficiales y otros hacia la comunidad y decisores como elemento esencial de propuestas de investigación en salud.
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SUBCOMITE DE RECURSOS HUMANOS CAPACITADOS (y capacidad en campos particulares) Desafios: • Contar con RRHH comprometidos y formados que, con estabilidad funcionaria puedan darle continuidad a los procesos. • Necesidad de mantener una pluralidad de perspectivas y una transdisciplinaridad en la formación y práctica de la investigación en salud o Enseñar y practicar la investigación con un buen grado de rigor metodológico, incluyendo la metodología cualitativa, y métodos mixtos (cuali-canti) o Enseñar la investigación con un enfoque participativo y de cambio • Necesidad de integrar la investigación en el curriculum de formación de profesionales de salud o Crear oportunidades y espacios para personal local capacitado. • Necesidad de crear condiciones laborales que fomentan y valorizan los investigadores o Capacitar y formar investigadores Amenazas Poca articulación universidad-estado para la orientación de la formación de recursos humanos Débil cultura de investigación en las universidades y en el cuerpo asistencial Pérdida de personal altamente calificada del sector público y universitario al sector privado, ONG, y colaboración internacional Oportunidades y fortalezas: Existe una masa crítica de personal altamente calificada (maestría y doctorado) El grado universitario por tesis es fuente de asistentes de investigación y permite una exposición práctica a la investigación La universidad pública universal crea un gran potencial de equidad social y de género en la formación de investigadores y asistentes de investigación Incorporarse dentro del sistema internacional de investigación y de aplicación de conocimientos Visión para recursos humanos capacitados Sabremos que hemos logrado mejores recursos humanos para la investigación en salud cuando se haya implementado un modelo académico de enseñanzaaprendizaje basado en la generación del conocimiento Valores y principios que orientan las acciones de recursos humanos capacitados • Trans-disciplinaridad • Inter-sectorialidad • Rigor metodológico • Reforzar la calidad y la producción de la universidad pública • Aproximación a y participación de la comunidad
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ACCIONES: Inmediato: Conformar un comité ad hoc de capacitación de recursos humanos • Formar recomendaciones para reorientación del curriculum de formación de profesionales de la salud para incorporar progresivamente el pensamiento crítico y la investigación en salud • Revalorizar las tesis de grado como metodologia de aprendizaje/enseñanza en investigacion • Fomentar la rigurosidad cientifica en forma progresiva en el pre y postgrado • Motivar la incorporacion de cientistas sociales y otros profesionales como agronomia/ing/economia/etc. en la investigacion en salud • Formular recomendaciones para mejorar las condiciónes laborales de Investigador@s • Profesionalización de docentes investigador@s • Acreditación académica a los investigadores de planta con niveles de maestría y doctorado. • Fomentar a la carreras en investigación • Impulsar la capacitación de docentes en investigación • Incorporar en la norma universitaria vigente un sistema de incentivos para investigación • Monitoreo de la calidad y cantidad de publicaciones • Incentivar la investigación en docentes de signatura • Recomendar acciones para reforzar el vínculo asistencial-investigación • Ampliacion de consejos/comites hospitalarios de ensenanza, • Fomentar la investigacion e interaccion social de diversas profesiones • Fomentar la base comunitaria en la formación y práctica de profesionales de la salud A corto plazo: Conformar el subcomité de recursos humanso capacitados dentro de la Sub-unidad de investigación en salud del MSD • Analizar las necesidades de personal en el país (investigadores, apoyo técnico y profesional a la investigación, gestión y gerencia de la investigación) • Establecer prioridades y modalidades para financiamiento de capacitación de recursos humanos • Establecer modalidades de financiamiento e incentivo de investigadores establecidos • Establecer prioridades y modalidades de mejoramiento de infraestructura de investigación en salud (universitario, centros de investigación, comunidad)
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SUB-COMITÉ DE ÉTICA Desafíos • Asegurar el funcionamiento de comités de aprobación ética en todos los departamentos o Conformación de voluntariados para los comité o Reuniones periódicas y regulares • Asegurarse que toda investigación en salud pase por aprobación ética o Acelerado (análisis secundario) o Liviano o Completo • Asegurarse que los requisitos éticos cumplen con las normas mínimas internacionales • Adaptar los requisitos éticos al cuadro particular latinoamericano y boliviano o Perspectiva eco-social o Perspectiva pueblos originarios o Control social de la ética en investigación con seres humanos Oportunidades y fortalezas o Comité nacional de bioética establecida y funcional con aval internacional o Potencial de liderazgo y renombre internacional en cuanto normas e instrumentos para la conducta ética de investigación con pueblos originarios o Contexto legislativo: ley de participación popular ley de descentralización que favorita la participación social en todo el proceso de investigación y en la definición de la ética de investigación Acciones concretas a corto plazo Inmediato: conformar un sub-comité ad hoc de ética o Definir pautas y normas interinas para aprobación ética de proyectos financiados en una convocatoria próxima o Establecer un plan para establecer comités departamentales de aprobación ética A corto plazo: Conformar el subcomité de ética dentro de la Sub-unidad de investigación en salud del MSD o Establecer pautas y normas para aprobación ética de proyectos financiados o Establecer procesos para velar sobre la conducta ética de investigaciones financiados
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Appendix E
CRONOGRAMA DE TRABAJO SISTEMA NACIONAL DE LA INVESTIGACIÒN EN SALUD
DICIEMBRE 2007 -MSD priorice y elige dentro de los 16 temas de la investigación en salud ENERO 2008 -Taller nacional para establecer líneas de prioridad -Identificar actores claves regionales FEBRERO 2008 -MSD priorice y elige dentro de las líneas de prioridad establecidas -Crear Comité Ad Hoc (y Sub-Comités) MARZO 2008 -Reunión de la Comité Ad Hoc (primera semana de Marzo) -Lanzamiento de la Convocatoria para Fondos Concursables (última semana) MAYO 2008 -Primera reunión del CONAIS JUNIO 2008 -Fecha limite para recepción de propuestas de investigación -Conformación de grupos para revisión de pares SEPTIEMBRE 2008 -Anuncio de resultados del Fondo Concursable DICIEMBRE 2008 -Conferencia/Congreso Nacional (sobre el Sistema y para presentar resultados)
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Appendix F Participants List
Dr. German Crespo
National Advisor and Coordinator of Cooperative Projects and Sectoral Planning/ MSD La Paz
Lic. Rory Narvaez
Programme Officer World Food Programme La Paz
Dr. Carlos Barrero O.
Coordinator of Departmental Health Project, Tarija
Dra. María Teresa Losada M. Kim Scott
Dra. Susana Rance Dra. Susana Ramirez Hita
Director of Primary Attention in Integrated Health Project San Lucas Foundation Cochabamba Principal Investigator Kishk Anaquot Health Research Canada
Professor and Researcher CIDES – UMSA Postgraduate in Development Sciences Universidad Mayor de San Andres La Paz Anthropologist Professor and Researcher La Paz
Physician Responsible for Area of Quality MSD Coordinator of the National Bioethics Committee Dr. Javier Luna Orosco
Dr. Zacarías Crespo Villegas
Carlos Erostegui
Marco Herbas Justiniano
Henry Solis Fuentes
Physician Director of Cristo de las Americas Hospital President of the Medical Institute of Sucre Physiologist Department of Education, Medicine and Planning Faculty of Medicine Universidad Mayor de San Simon Cochabamba Physician Technical and Development Manager of APROSAR (NGO) Family Physician Head of Teaching and Research Department of Social and Family Medicine Universidad de San Simon Cochabamba
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Ridmar M. Velasquez Torrico. MD
Eduardo L. Suarez Barrientos MD, MSC
Sara G. Perez Lara MSc.
Action International for Health Activist Professor and Researcher Faculty of Medicine Institute of Biomedical Research Universidad de San Simon Cochabamba Professor and Researcher SELADIS Institute (Pharmaceuticals and Biochemistry) Universidad Mayor de San Andres La Paz Biochemist and Researcher Centre for Research on Tropical Diseases (CENETROP) Santa Cruz
Lorena M. Soleto Ortiz Mary Cruz Torrico Rojas
IIBISMED Faculty of Medicine Universidad Mayor de San Simon Cochabamba MSD, Planning Unit La Paz
Tara Elvira Bickis Professor and Researcher Coordinator of the Centre for Planning and Management (CEPLAG) Universidad Mayor de San Simon Cochabamba Carmen Ledo Garcia
Dr. Jeannie Haggerty
CCGHR Co-Chair Bolivia Canada Team University of Sherbrooke Canada
Maija Kagis
CCGHR Bolivia Canada Team Health Systems Consultant Canada
Jill Murphy
CCGHR Project Officer Canada
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