|ORIGINAL RESEARCH PAPER
|Year : 2007 | Volume
| Issue : 2 | Page : 53
Creating and Testing the Concept of an Academic NGO for Enhancing Health Equity: A New Mode of Knowledge Production?
V Robinson1, P Tugwell1, P Walker1, Aleida A Ter Kuile2, V Neufeld2, J Hatcher-Roberts1, C Amaratunga1, N Andersson3, M Doull1, R Labonte1, W Muckle4, F Murangira5, C Nyamai6, D Ralph-Robinson7, D Simpson7, C Sitthi-Amorn8, J Turnbull9, J Walker1, C Wood6
1 Institute of Population Health, University of Ottawa, ON, Canada
2 Canadian Coalition for Global Health Research, Ottawa, ON, Canada
3 CIET Canada, Ottawa, ON, Canada
4 Ottawa Inner City Health Initiative, Ottawa, ON, Canada
5 Somerset West Community Health Centre, Ottawa, ON, Canada
6 AfriAfya, Nairobi, Kenya
7 Innovation Expedition, London, ON, Canada
8 Chulalongkorn University, Patumwan, Bangkok, Thailand
9 The Ottawa Hospital, Ottawa ON, Canada
|Date of Submission||21-Jun-2007|
|Date of Web Publication||21-Aug-2007|
1 Stewart Street, Ottawa, ON, Canada, K1N-6N5
Source of Support: None, Conflict of Interest: None
Context: Collaborative action is required to address persistent and systematic health inequities which exist for most diseases in most countries of the world.
Objectives: The Academic NGO initiative (ACANGO) described in this paper was set up as a focused network giving priority to twinned partnerships between Academic research centres and community-based NGOs. ACANGO aims to capture the strengths of both in order to build consensus among stakeholders, engage the community, focus on leadership training, shared management and resource development and deployment.
Methods: A conceptual model was developed through a series of community consultations. This model was tested with four academic-community challenge projects based in Kenya, Canada, Thailand and Rwanda and an online forum and coordinating hub based at the University of Ottawa.
Findings: Between February 2005 and February 2007, each of the four challenge projects was able to show specific outputs, outcomes and impacts related to enhancing health equity through the relevant production and application of knowledge.
Conclusions: The ACANGO initiative model and network has demonstrated success in enhancing the production and use of knowledge in program design and implementation for vulnerable populations.
|How to cite this article:|
Robinson V, Tugwell P, Walker P, Ter Kuile AA, Neufeld V, Hatcher-Roberts J, Amaratunga C, Andersson N, Doull M, Labonte R, Muckle W, Murangira F, Nyamai C, Ralph-Robinson D, Simpson D, Sitthi-Amorn C, Turnbull J, Walker J, Wood C. Creating and Testing the Concept of an Academic NGO for Enhancing Health Equity: A New Mode of Knowledge Production?. Educ Health 2007;20:53
|How to cite this URL:|
Robinson V, Tugwell P, Walker P, Ter Kuile AA, Neufeld V, Hatcher-Roberts J, Amaratunga C, Andersson N, Doull M, Labonte R, Muckle W, Murangira F, Nyamai C, Ralph-Robinson D, Simpson D, Sitthi-Amorn C, Turnbull J, Walker J, Wood C. Creating and Testing the Concept of an Academic NGO for Enhancing Health Equity: A New Mode of Knowledge Production?. Educ Health [serial online] 2007 [cited 2020 Sep 25];20:53. Available from: http://www.educationforhealth.net/text.asp?2007/20/2/53/101619
Continued and worsening disparities in health both between and within countries represent a major challenge to all those committed to enhancing global health equity (Evans, 2001, Reaching the Poor, 2005). Meeting this challenge requires a new mode of knowledge production where scientists, civil society and governments collaborate to produce locally relevant and “socially robust” knowledge which is used to extract social, economic and health benefits through the development of innovative programs that bridge the know-do gap (Gibbons, 1999).
While this presents an idealized situation of shared commitment to equity and cooperation, there is nonetheless recognition internationally of the need for methods to get research into policy and practice. For example, the 2005 58th World Health Assembly resolution marked a landmark commitment to knowledge translation by urging member states: “to establish or strengthen mechanisms to transfer knowledge in support of evidence-based public health and health-care delivery systems, and evidence-based health-related policies”(WHA, 2005). Initiatives in Canada and internationally reflecting this commitment to knowledge translation include the Canadian Coalition for Global Health Research Task Group on Research to Action, the International Development Research Centre Research Matters Initiative (IDRC, 2006) and the World Health Organization Evidence-informed Policy network (Hamid, 2005).
Networks can accelerate the transfer of relevant knowledge into evidence-based public health and policies (IDRC, 2003, Mendizabal, 2006). For example, the Network: TUFH (Towards Unity for Health) has demonstrated innovations in public health systems and services (Bryant et al., 2001). Other examples include Canada’s International Immunization Program (CPHA, 1995), the Global Equity Gauge Alliance (McCoy et al., 2003) and the International Network of field sites with continuous Demographic Evaluation of Populations and Their Health in developing countries (INDEPTH) (Ngom, 2001).
These networks bring together multiple disciplines and sectors combining both the social and political process to put relevant knowledge into action. Collaboration between science and civil society has been embraced as an essential component of ensuring relevance by social accountability initiatives of universities (AFMC, 2001), the private sector and governments (Wiseman et al., 2003).
The Academic NGO initiative (ACANGO) is a focused network giving priority to twinned partnerships between academic centres and community-based NGOs. ACANGO aims to capture the strengths of both in order to build consensus among stakeholders, engage the community, focus on leadership training, shared management and resource development and deployment. ACANGO aims to enhance health equity through the production and use of relevant knowledge (Table 1).
The aims of ACANGO fit the four criteria for the Network: TUFH projects to develop innovative services for integrating medicine and public health; consider implications for health professionals; build partnerships with key stakeholders; and demonstrate evidence of impact. This paper describes the development and testing of the ACANGO network using four challenge projects in Kenya, Thailand, Rwanda and Canada to test collaborative production and utilization of knowledge.
Table 1: Guiding Principles for the Academic NGO
The ACANGO initiative was developed by three phases of consensus-building among stakeholders from academia, community, NGOs, practitioners, government and funding agencies. Each phase engaged stakeholders in email dialogue and face-to-face meetings to make joint decisions about resources and management.
Phase 1: Internal dialogue and meeting to gauge academic’s support for ACANGO concept
An email dialogue was conducted using a structured process developed by Innovation Expedition from January 2003 to May 2003 with 20 University of Ottawa researchers with experience working with community partners. Feedback from the email dialogue was discussed at a one-day face-to-face meeting, where we proposed constructively combining the strengths of academe and NGOs (Table 2). We did not focus on limitations of different organizations since this was counterproductive towards developing trust and building partnerships. After this meeting, University of Ottawa researchers enthusiastically supported further exploration of the ACANGO concept.
Table 2: Academic and NGO strengths
Phase 2: External dialogue and meeting to gauge academic, NGO and funder’s support
A similar email dialogue was conducted from February to June 2004, with over 100 local and international researchers, NGO representatives and funders. Four ongoing projects were used as challenge projects to demonstrate and test the value of the evolving model. A two-day meeting was held at the University of Ottawa, with participation from 42 multidisciplinary organizations from 11 countries consisting of 15 NGOs, 12 academic institutions, eight low and middle income countries (LMIC) and two funders (Appendix 1).
At this meeting, participants co-created a conceptual framework for the ACANGO initiative, including roles of academe, NGOs and clients defined by six Ps (Public, Practitioner, Press, Policy-maker, Private sector, Patient) [Figure 1]. In this conceptual framework, regional action partnerships of all key stakeholders (academic institutions, NGOs and community) assess community-based health needs of vulnerable populations then draw on evidence-based resources (such as training, dialogue and repository available in the ACANGO e-House) to develop innovative health interventions (practices and projects).
Figure 1: Academic NGO Conceptual Framework.
Phase 3: Implementation and testing
Based on this enthusiasm, the University of Ottawa decided to create an online forum (the e-house), and test the value of the ACANGO framework in four challenge projects, launched in February 2005.
This paper describes results of these four projects from February 2005 to February 2007. The four projects were AfriAfya, Ottawa Inner City Health Initiative (OICHI), Global Ottawa AIDS Link (GOAL) and Chulalongkorn University.
AfriAfya is an NGO in Nairobi, Kenya, which works as the coordinating Hub for field sites, collecting and disseminating information to local change agents and training them to apply information communication technology to access, produce and share health and other development information. Change agents are volunteers (e.g. school teachers or retired practitioners) who interact directly with community members. AfriAfya was drawn to ACANGO by interest in assessing community impact and further developing their knowledge management capacity.
OICHI, an NGO based in Ottawa, Canada was established in 2001 to address the health of people who are chronically homeless with complex health needs. The project has enjoyed success in improving health, appropriate utilization of health services, housing and reducing harm from substance abuse for the chronically homeless. OICHI sought evidence on helping their clients eliminate antisocial behaviors such as panhandling and criminal activity.
The GOAL project is building the capacity of the local community in Ottawa and Rwanda to respond to the needs of ethnoracial and ethnocultural communities with respect to HIV/AIDS prevention and intervention. The project aims to contribute to domestic and global learning about effective HIV/AIDS prevention and community care strategies, particularly related to overcoming socio-cultural taboos and systemic racism.
Chulalongkorn University is developing youth sexual health counseling services in collaboration with community partners including a Bangkok Metropolitan Association health centre, secondary school and the Chulalongkorn Hospital. Initiatives include a sexual health hotline and promoting and evaluating sex education in high schools.
Building partnerships with key stakeholders
The ACANGO conceptual framework embraces a vision where knowledge is co-created by collaboration between academics, NGOs and clients [Figure 1 and table 3].
Each of the challenge projects has built partnerships with key stakeholders, as the first step in developing evidence-based, innovative services for health practitioners. For example, the University of Ottawa and Chulalongkorn University developed a partnership with the sexual health counseling centre by assessing decision-making needs of Thai youth using the University of Ottawa evidence-based decision support framework (Doull, 2004). This assessment is now being used to develop decision support interventions for counselors.
Table 3: Five ACANGO Principles Modeled by Four Challenge Projects
The roles of each stakeholder have varied depending on community needs and interests of stakeholders. In some cases, the roles of stakeholders have broken traditional perceived roles of academics and NGOs. For example, NGO members are leading a systematic review on harm reduction and conversely, University of Ottawa members are actively involved in raising funds through lobbying for the GOAL project.
Seed funding and internships have been instrumental in developing partnerships. AfriAfya and the University of Ottawa received a development grant from the Canadian Institutes of Health Research (CIHR) which allowed them to host an East Africa regional workshop to build relationships between key stakeholders from four nearby academic institutions and seven NGOs in January 2005. A CIHR development grant received by GOAL funded extensive community consultations and identified a specific research plan with mechanisms for community participation which led to a successful proposal to the Canadian International Development Agency. Internship funding helped develop partnerships between the University of Ottawa and NGOs such as AfriAfya and OICHI.
Implications for health professionals
Knowledge needs to be contextualized to consider implications for health practitioners since research users need to know more than “what works” but also why, for whom and in what setting (Lavis, 2006).
Extensive community consultation has been used to develop priorities. For example, the GOAL project, with leadership from the Ottawa Caribbean and African immigrant and refugee communities, examined how race, culture and gender influence health in relation to HIV/AIDS, and how this knowledge can be used to modify programs. This knowledge is now being used to strengthen the respective assets and capacities of different preventive programs in order to reduce the negative impact of HIV/AIDS on women and men in specific communities, both in Ottawa and Butare.
ACANGO projects have developed resources that have implications for the health professions and training. For example, the ACANGO challenge project with Chulalongkorn University has resulted in the research and development of a decision-support training module in Thai for the sexual health counselors that is contextualized to the needs of Thai youth and counselors. This evidence-based decision support is now being tested as a component of sexual health curricula at Chulalongkorn University.
Innovative services for integrating medicine and public health
Each of the ACANGO challenge projects has a focus on five principles to integrate medicine and public health: 1) community orientation of academic faculties of health sciences; 2) focus on vulnerable populations, defined across socioeconomic and demographic factors; 3) assessment of health needs; 4) evidence-based practice, and 5) developing and testing innovative services (Table 3).
Several of the challenge projects have received recognition for their innovative services for public health. For example, AfriAfya received an award from The Tech Museums for success using information communication technology to improve access to information through local community communicators. AfriAfya was invited to the World Society for Information Science to showcase their key projects working on e-health in collaboration with the Kenya Ministry of Health. OICHI has successfully received core funding from the Ontario Ministry of Health - a remarkable achievement since many of their activities are outside of the health sector.
The ACANGO online e-house brings diverse stakeholders together to develop innovative solutions to community-generated, population-based questions through knowledge-sharing. Action Learning Forums were run on our website on four topics (available at www.acango.org). The action learning topics were: 1) Health system strengthening; 2) Role of NGOs in revitalising academic health; 3) Learning within the ACANGO network, and 4) Working on adherence - community based health workers.
Evidence of impact
ACANGO developed a framework to evaluate outputs, outcomes and impact (see Figure 1 and Table 4).
Table 4: Evidence of Impact in Four ACANGO Challenge Projects
Outputs include research proposals, publications, capacity-building and best practices. Four research proposals were funded. Other unsuccessful research proposals increased the capacity of participating organizations to develop grant proposals. ACANGO has resulted in poster presentations at international conferences including the World Congress of Epidemiology (Cheumchit & Doull, 2005) and the Canadian Conference for International Health. Publications include a literature review on narratives and a peer-reviewed publication on decision-making skills (Doull et al., 2006). Several projects have included capacity building activities such as training interns and specialized training for project leaders (e.g. in participatory community evaluation). Resources from four action learning forums are available at www.acango.org.
Outcomes include innovative practices and projects, tailored educational programs and collaborative knowledge networks. Innovative practices to improve population health are being tested out in each project (e.g. testing narratives for prevention and health promotion, training in decision support for sexual health counselors, promoting health in hairdressing salons). Each of these innovations involves knowledge translation with tailored educational programs adapted for specific audiences. The online action learning forums developed collaborative knowledge networks where members asked questions and drew on expertise of other members.
Impact is defined as changes in policy, practice and health outcomes. Since these projects have only been running for two years, there is no evidence of changes in health outcomes yet. However, changes in practice and policy include AfriAfya drawing on the Cochrane Library as a source for evidence and OICHI testing narratives for knowledge translation. Furthermore, the University of Ottawa has achieved support from senior administration for a program of Global Academic Partnership to bridge ACANGO principles to revitalize academic health sciences curricula to respond to needs of vulnerable populations.
The ACANGO network has shown early evidence of impact of collaborative knowledge production between society and academia, with a focus on evaluation. The ACANGO network fits the four criteria for the Network: TUFH case study projects to develop innovative services for integrating medicine and public health, consider implications for health professionals, build partnerships with key stakeholders and demonstrate evidence of impact (Neufeld, 2001). Of course, achievements of these four challenge projects cannot solely be attributed to academic-NGO partnerships since much of the ongoing success is due to the commitment of individuals active in each of these initiatives.
In the ACANGO model, complementary expertise and skills of academic institutions and NGOs enhance the translation of knowledge into locally relevant programs and policies. Other models of bringing together academic and NGO expertise include having internal research departments within NGOs as well as contracting out research activities to academic consultants or research organizations (Ledogar & Andersson, 2002; Delisle, 2005).
University credit systems for tenure are a barrier to university-based researchers working with NGOs, since outcomes of changing practice and policy are rarely recognized. However, universities and community researchers are working on changing reward systems to recognize impact on society at the level of individual universities (Steiner, 2005) as well as the national level such as initiatives in the Netherlands to consider impact and relevance (Council for Medical Sciences 2002, KNAW, 2003). In Canada, the University of Toronto department of psychiatry adapted academic promotion criteria to include impact on professional practice, the public or policy (CHSRF, 2006).
Science as a public service may not meet health research funders’ expectations. Canadian funding agencies seem hesitant to invest in academic-NGO partnerships except in strategic initiatives which aim to engage research users in the production and use of knowledge (e.g. CIHR Knowledge Translation Initiatives). However, CIHR has recently allowed members of NGOs to apply as principal investigator (previously only university-based researchers could do so). The Canadian Health Services Research Foundation “Recognition” program is collecting best practices in rewarding academic participation in knowledge translation, including partnering with community-based organizations and NGOs (Recognition, 2006).
The time pressures faced by NGOs to implement programs are a barrier to collaboration with academic institutions. ACANGO is challenging both academics and NGOs to work together towards realistic timelines.
The ACANGO e-house online forum has resulted in a rich collection of best practices. Several ACANGO members have described personal benefit in terms of knowledge gained and new collaborative relationships due to participation in the e-house. The next step is development of global academic partnership based on twinning relationships between community-oriented universities in low and middle income countries with the University of Ottawa to enhance academic health sciences curricula with a focus on assessing and responding to needs of local vulnerable populations.
ACANGO partnerships have demonstrated significant achievements in producing and using relevant knowledge, with several funded grants and publications as well as development of innovative services which integrate medicine and public health using tailored educational approaches. The next step is testing the ACANGO model in revitalizing academic health sciences curricula with a focus on population health and health equity. The ACANGO model of using knowledge for partnership in enhancing health equity has commitment from the senior administration at the University of Ottawa and is developing agreements with partners to seek greater sustainability by institutionalizing ACANGO principles, for example by incorporating them into health sciences curricula. Continuous evaluation of activities has been helpful in securing institutional support and maintaining momentum and enthusiasm.
Vivian Robinson and Marion Doull are supported by doctoral fellowships from the Canadian Institutes of Health Research; Peter Tugwell is supported by a government of Canada Research Chair in Health Equity; Ron Labonte is supported by a Canada Research Chair in Globalization; Carol Amaratunga holds the Ontario Women's Health Council Chair, University of Ottawa. Marion Doull received a Netcorps internship.
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Appendix 1: Organizations Represented in the External Consultation of the ACANGO Dialogue