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Editorial

Guest Editor

Improving halthcare delivery for the many who can ill afford it
By Prof. Daniel Kaseje
Vice Chancellor
Great Lakes University of Kisumu (GLUK)

In spite of the general increase in the wealth of many countries, one of the most preoccupying concerns of many communities is the existence of large segments of the population who have no access to adequate health care. Increase in global prosperity and technological advancement tends to benefit a minute minority of the global population while the majority is left wallowing in poverty and ill-health, due to uneven playing field in the global market place.  

The extent to which people benefit from a globalized economy and technological advances depends on their intrinsic ability to engage their resource base and level of control they have over local and global factors influencing their context and control over interventions intended to improve their situation. Thus people rendered vulnerable by factors beyond their control need the backing and support from a number of partners such as the public sector, academic institutions, and the private sector, to complement their efforts based on their own perspectives, but not a displacement of their initiatives. For this to happen, it is necessary that real and effective partnership is developed between the “helpers” and “those being helped” in order for sustainable outcomes to be achieved. In this sense the notion of partnership goes beyond that of participation. 

The collection of studies in this issue is a timely addition to the ammunition currently available to the health and development worker at the district level, as they describe what can be achieved working with people as partners in their own health and development efforts. If internalized, translated into practice and implemented on a large enough scale, then the achievement of MDGs may be a reality. 

These studies were developed on theory based models of sustainable improvement in wellbeing of communities. As part of its academic and research activities, the Great Lakes University of Kisumu has developed, tested and replicated a number of these models in search of best methods to enhance performance towards sustainable improvement in health outcomes. These include applied collaborative research bringing together researchers, policy makers and communities to engage together in the search for solutions to complex systems based problems, to improve the performance of the service system. A deliberate effort was made to move past research-driven processes towards the co-production of results and a deeper appreciation of research at the policy level. The three groups of stakeholders establish a shared understanding about the questions to ask, how to answer them, and how to select information to apply to processes of continuous improvement and policy making. Each research question is framed to be able to lead to supporting management and policy decisions. 

Convening deliberative dialogues was key in building relationships, establishing trust and  discussing the needs and realities of both research and policy. Discussing and streamlining project processes, refining the production of results and making decisions on their possible adaptation and application at all levels, including the community level. Such dialogues may concern: data interpretation to specify relevant evidence for action; using or demanding evidence to draw relevant and applicable conclusions towards policy development; designing, planning interventions for addressing problems identified in thorough research; designing research-informed programmes and activities; designing further research questions from a discussion of results; and discussing and developing products that can be used for policy advocacy. Any dialogue must generate clear, action-oriented results, searching for novel methodologies approaches.  
Applying knowledge management and evaluative thinking techniques and approaches to ensure that they are adequately and dynamically capturing, storing, understanding, synthesizing and providing information for processes of continuous improvement at all levels. The process ends with synthesis papers outlining progress, lessons, achievements and shortcomings, and a road-map for integrating these lessons and experiences into future activities. Some of these are published in this issue of AJFAND. 

The collection of studies in this issue is a timely addition to the ammunition currently available to the health and development worker at the district level, as they describe what can be achieved working with people as partners in their own health and development efforts. If internalized, translated into practice and implemented on a large enough scale, then the achievement of MDGs (reduction of poverty and hunger, improvement in gender equity, reduction in child and maternal mortality and the reduction of malaria and HIV disease burden) may be a reality. 

Community based information system (CBIS) was developed as a mechanism to include community partners in actual data collection and analysis. It is an analytical and planning tool to help planners and decision makers to design and implement programs that would ensure the frontline role of the community in determining the interventions that can make a meaningful contribution to their situation. In this way individuals and communities can promote continuous improvement of their situation through evidence based planning and use of resources. 

Essential Elements of Dignified Living (EEDL) was applied as a common set of goals for all partners to take decisions and action and ensure individuals and households realize dignified living and sustainable development. The model introduces the notion of “dignified living” to replace “standard of living”, and provides a set of seven elements of critical concern to communities: guaranteed access to food, income, health care, education, shelter water and sanitation, social capital and security. These elements are similar to MDGs but were identified and published in the year 2000 by TICH, before the MDGs. 

These models have proved that it is possible to reverse the declining health indicators in Kenya and achieve a remarkable improvement in health, service delivery and health outcomes in a relatively short period of time. The articles describe improvements in service coverage, utilization rates and health outcomes.  

This collaborative research partnership has resulted in a policy decision to adopt the community based approach, the community strategy by the Ministry of Public Health for the implementation of the Kenya Essential Package of care for Health (KEPH) and to accelerate the achievement of MDGs 1,4, 5, 6, and 7. The approach was also fed into the reformulation of the “Revitalization of Primary Health Care” by the World Health Organization regional office for Africa and was therefore reflected in the Oagadougou Declaration of April 30, 2008. The University is struggling to focus application to food and income security in the light of the on-going global food crisis and continuing grinding poverty by establishing the Department of Agribusiness to spearhead the effort. It is our hope that the readers of these articles would translate the messages into action to accelerate progress towards the MDGs.

By Prof. Daniel Kaseje
Vice Chancellor
Great Lakes University of Kisumu (GLUK)

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