Workshops at PHASA 2013

Do traditional medicines work? Learn how systematic reviews and meta-analysis can assist you to appraise the evidence base

Facilitators:   

Nandi Siegfried, South African Herbal Science and Medicine Institute, University of Western Cape and Amber Abrams, South African Cochrane Centre, Medical Research Council

Key messages:

Use of indigenous herbal medicines is widespread in Africa, yet research evidence on effectiveness is limited. Systematic reviews and meta-analysis synthesize the existing primary research on a topic to establish whether or not there is conclusive evidence about specific interventions. Our PHASA 2013 workshop aimed to build participants’ knowledge and skills to understand and interpret systematic reviews and meta-analysis in the context of indigenous herbal medicine.

Over 20 participants attended the 3.5 hour workshop, including medical students, researchers from non-governmental research organizations and universities, and staff from a provincial health department. Through a facilitator-led plenary presentation and discussion we introduced participants to the methods underpinning systematic reviews and meta-analysis. Participants worked together in small groups to critically appraise a Cochrane systematic review on the effectiveness of the herbal medicine derived from the South African plant, Pelargonium sidoides (isiXhosa: Umckaloabo), indicated for relief of upper respiratory tract infection symptoms. Through this process, they learnt to interpret the statistics presented in a forest plot (the graph produced by a meta-analysis). After tea, we demonstrated searching The Cochrane Library database for indigenous plant medicines, introduced participants to the recently launched e-learning modules on Clinical Trials of Indigenous Medicines hosted by the University of the Western Cape, and explored other resources for evidence including the Pan African Clinical Trials Registry.

Participants completed an evaluation and praised the high level of interactivity and the usefulness of the tools we demonstrated. Several participants suggested we include information on the effectiveness of herbal medicines currently in use in South Africa and we look forward to doing so at PHASA 2014. We are grateful to the PHASA organisers for the opportunity to present this workshop and thank the participants for their active engagement.

More information:

E-learning Clinical Trials of Indigenous Medicines (MUTHI): Prof Gail Hughes 

The Cochrane Library and Cochrane reviews: Ms Joy Oliver 

Building epidemiology capacity in South Africa

Facilitators:

Prof Noddy Jinabhai, Dr. Natalie Mayet, Dr. Carl Reddy, Dr. Seymour Williams

Key messages:

There is an urgent and unmet need in South Africa (SA) to develop and deploy epidemiologists and to increase the epidemiology competencies of staff in the public health sector. Based on international norms of 1 epidemiologist per 200 000 population, SA requires at least 250 epidemiologists. It is uncertain how many epidemiologists there are in the country. There is also limited information on the number of staff performing epidemiological functions in the public health sector.

To this end, the South African Field Epidemiology and Laboratory Training Program (SAFELTP) hosted a workshop that brought key stakeholders in the public health sector together, including academics, researchers, medical science students, representatives from the Department of Health (DoH), and the NGO Sector to share experiences and have a common understanding of:

The pivotal role that epidemiology can play in transforming the current health service;
Reviewing  a rapid appraisal of current epidemiology training in SA;
Exploring different models of best practice in building epidemiology capacity –Brazil/UK/USA;
To constitute an Epidemiology Working Group to take forward the deliberations of the workshop and determine:

  • What epidemiology competencies are required by various cadres of HCWs;
  • Where in the current and proposed DoH structures epidemiologists should be placed;
  • The most appropriate epidemiological capacity building model for South Africa.

The Epidemiology Working Group was constituted by five volunteers and will report to the National Surveillance Forum which is currently chaired by Dr. F Benson on behalf of the Deputy Minister of Health. The names of the volunteers will be submitted to the DDG and to the Deputy Minister of Health for approval and they will nominate additional members.

The Working Group will initially be very busy establishing its Terms of Reference (TOR), ensuring institutional representation, exploring the setting up of a PHASA special interest group to pursue some of its activities and will report back to PHASA next year in terms of a review of lessons learnt, achievements, challenges and the way forward. 

Building effective mHealth strategies to reach low-income and low-technology populations

Facilitators:

Victoria Nembaware, Tash Sundar, Annie Neo Parsons and Katherine de Tolly; Cell-Life NPO, Cape Town.

This workshop was funded by the Canadian International Development Agency and facilitated by Cell-Life staff. The workshop aimed to familiarize participants with the mHealth field by sharing lessons learnt from designing, implementing and M&E of mHealth projects at Cell-Life.

More than 25 people from a range of organisations and government departments attended and actively participated. The workshop ended with group work where attendees brainstormed about mHealth services for participant-specified mHealth research/implementation questions.

Key messages:

  1. mHealth services can supplement other traditional approaches or exist as standalone services.
  2. Before implementation, it is important to understand the problem that the mHealth service is aiming to address and cellphone usage behaviours of the target audience.
  3. Using cellphone-based technologies for health-related projects has advantages and disadvantages. Choose a technology/ies most suitable to your target audience and project.
  4. Constant monitoring, evaluation and adapting of mHealth services is critical to their success. Monitor key areas of implementation such as use of the technology, and acceptability of services and content by users and/or implementers.
  5. Always implement mHealth services in an ethical manner. For example, consider and address factors such as disclosure concerns, informed consent and compliance with the Wireless Application Service Providers' Association (WASPA) code of conduct.
  6. Government needs to create policy and an environment that enables the mHealth field to succeed.

Laying the foundation for a critical public health in Africa

Facilitators:

Dr. Christopher J. Colvin, Dr. Alex Mueller, and Ms. Alison Swartz, School of Public Health and Family Medicine, University of Cape Town.

Key messages:

The concept of ‘critical public health’ refers to an approach to public health training, research and activism that emphasizes critical thinking and reflective practice.  It moves both beyond technocratic and individualistic approaches as well as beyond ‘mere critique’ for the sake of critique, and attempts to understand how power, inequality, and discrimination at all levels produce and reproduce the conditions for ill health and how public health might actively engage in transforming some of these broader social determinants of health.

The workshop facilitators presented brief case studies of their own work in critical public health, discussed a longer case study on the dilemmas of neonatal care in Africa, and even played a round of the ‘Game of Questions’. During the workshop, participants discussed their own experiences and difficulties with balancing the need for regular critical thinking and reflection on practice with the overwhelming demands and needs they face in their day-to-day work.  It was agreed that the challenge is not so much an either/or choice between unthinking action and thoughtful inaction, but rather about how we can better organize our daily lives in public health to both allow for sustained critical reflection and develop the opportunities for translating these reflections into better teaching, research and practice. 

Supporting public health policy development and advocacy in Africa

Facilitators:

Jim Chauvin, President, WFPHA; Prof. Amir Attaran, University of Ottawa, Canada; Debbie Klein Walker, Vina HuLamm and Regina Davies, APHA;  Laetitia Rispel and Stephen Knight, PHASA.

Key messages:

On September 25 the World Federation of Public Health Associations (WFPHA) organized and hosted a pilot policy development and advocacy (PD&A) skills-building workshop for public health associations (PHAs) in Africa. This event served to draw on their experiences and lessons learned in policy development and advocacy as a means to help participants gain increased understanding of the ‘do’s and don’ts’ in public health policy advocacy. The issue of falsely-labelled and falsified medicines was used as an example for framing an advocacy campaign action plan by PHAs at the national and continental levels on an important public health issue. This workshop was proposed as a component of the WFPHA’s Public Health Associations for Equity (PHA4Equity) proposal developed by Laetitia Rispel for the WFPHA at an earlier meeting, and endorsed by the WFPHA Governing Council.

Representatives of public health associations from several African countries (South Africa, Mozambique, Malawi, Nigeria and Kenya) attended the workshop as did representatives from several other African NGOs and other interested parties. Some PHA representatives who had been invited were unable to attend at the last minute, but their absence was made up by the participation of a large delegation from Nigeria (a country which has begun to tackle the medicine quality issue) and several observers who joined the workshop.

Representatives from the American Public Health Association (Debbie Klein Walker, Vina HuLamm and Regina Davies) acted as co-facilitators for part of the workshop and briefed the workshop participants about a new and updated resource toolkit on policy development and advocacy for public health associations which is being prepared by WFPHA for its member associations. Prof. Amir Attaran of the Faculty of Law at the University of Ottawa (Canada) was a speaker and technical advisor during the workshop on the issue of falsely-labelled and falsified medicines. Laetitia Rispel made welcoming comments and Stephen Knight of PHASA and Jim Chauvin, WFPHA’s President, co-presented the opening presentation.

The workshop achieved its objectives. A communiqué was released following the workshop in which a commitment was made by PHAs and the WFPHA to work together to begin assembling country-based evidence about the extent of the falsely-labelled and falsified medicine situation and an environmental scan as to what is being done to address the issue. They also agreed to work together to bring the issue to the attention of the African Union and to push WHO to take action on it. The WFPHA will also continue to develop the policy development and advocacy toolkit, and will explore the feasibility of future PD&A workshops in other regions, culminating in a major workshop on this issue at the 14th World Congress on Public Health (Kolkata: February 2015).

Dr. Amir Attaran making his presentation

Dr. Amir Attaran making his presentation during the policy development & advocacy workshop.

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