What I learnt from my first health system research project

Dr Praveenkumar Aivalli blogs here about his experiences on his first research project funded by the World Health Organization in South Indian State. If you’re starting your first research project in a poor resource setting you may relate to this.

Starting my first research project

Back in 2013, I just stepped out of my university after getting my Master of Public Health degree, in no time I was given an excellent opportunity to work on a World Health Organization (WHO) funded health system research project in one of the reputed public health research institutes in Bangalore. It was the first research project of my public health career and as a new bee, I was buzzing with excitement and enthusiasm about the study.

The project was on improving NCD (Non Communicable Diseases) care at primary health centers in one of the districts in south India. It was a quasi experimental study trying to understand the impact of health system interventions through a baseline and end line household and facility surveys.

For better coordination, exposure and learning, I was placed in the study district. Having completed most of my education in the country, it was not that difficult for me to understand our country’s health system.

We visited more than 1000 families to get data on NCD care at the rural level, health seeking behaviors of NCD patients and their out pocket expenditures for NCD care.

The theoretical explanations from classrooms started fitting in its notches when I got exposed to the field during the early days of the project. I got the hang of the project fairly quickly and began preparing for the baseline survey in the year of 2013.

We visited more than 1000 families to get data on NCD care at the rural level, health seeking behaviors of NCD patients and their out pocket expenditures for NCD care. We also visited primary health centers and private pharmacies in the area to collect information on medicine availability.

Gaining first-hand experience

Slowly I started seeing things from the field, which I had never seen or read before in any textbooks and I realized the importance of seeing things first hand. In one of my earlier blog posts I have shared one such experience, about how old people with NCDs are neglected in south India.

After the baseline survey, we started with our study interventions. The response to our intervention on improving NCD care at public health centers was fairly good and well absorbed by the system. However, we ensured that we visited these public health centers periodically to understand how the intervention is progressing and also to give technical support for better performance.

As a young public health professional, even minor changes in NCD care at health centers kept my motivation high and I often used to feel good about the interventions.

During these visits, I started noticing the changes in the centers; though I am aware that as a researcher, one should limit yourself to finding answers to your research questions and be neutral about the results.

As a young public health professional, even minor changes in NCD care at health centers kept my motivation high and I often used to feel good about the interventions. Everything was just fantastic until we started the end line survey.

Two years since the start of the project

The end line survey began in 2015-16 where we visited the same households to measure the change in people’s lives with regard to NCD management; it was a bit disheartening to know that mortality and morbidity patterns were high.

It was clear that there were no big changes in their lives in terms of health seeking behaviors and out pocket expenditure on NCDs. It made me rethink and question myself – do health system interventions really bring change in people’s lives?

Though two years could be too short to look for the impact of an intervention, still as a rookie in public health research, it is a bit demotivating to notice that there is not much change in NCD peoples lives.

However, towards the end of the project, I learnt the art of being neutral to the results, I become less attached to the project intervention, and started to accept the reality and began moving forward.

What did I learn?

I write this blog as I have heard many of my young colleagues share the same dilemma.

I write this blog as I have heard many of my young colleagues share the same dilemma. I want to reiterate that it is difficult to bring in changes within a short period, as the health system is very complex and we work in a resource poor setting.

There are no shortcut methods through which we can bring in change to people’s lives in a short span of time. Many times these issues are much beyond the view of health service delivery.

I believe that my experiences and learnings from my first project might not be an isolated experience and it would definitely guide a lot of beginners who are stepping into the ocean of health system research.

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