National situation analyses of current policy and health system contexts

The main task of WP5 is now complete and the final report was submitted to the EC on 30 March 2011.   Work Package 5 is led by Peter Phillimore, and Shahaduz Zaman at Newcastle University, with input from the Mediterranean Partners in Turkey, Syria, Palestine and Tunisia.

Summary Report available here: WP5 Final Report Summary            
Full report available on request

The objectives of this work package are to:
- Use established schematic frameworks of potentially effective policy measures and health system interventions for the prevention of CVD and Type 2 diabetes in order to guide data collection and analysis
- Identify, collate and systematically review all relevant documentary materials on policies and health service provision
- Explore perceptions and knowledge of relevant national policies through interviews with key informants from relevant organisations, including government, the health sector, private sector and non-governmental organisations (including patient groups)
- Explore health beliefs with potential target groups, and determine whether these differ by population group, including by gender and socio-economic group.

Completion of WP5

The WP5 Report to the EC comprises two parts: Part A, the Overview of the work package, including an account of the overall research design; and Part B, by far the larger, made up of the four country reports by partner teams.

The overall aim of WP5 within MedCHAMPS has been twofold: firstly to undertake a situation analysis of current CVD and diabetes policy in the four partner countries (namely Palestine, Tunisia, Turkey and Syria); and secondly to analyse the contexts in which health systems manage CVD and diabetes in these countries, at a regional and sub-regional level.

To achieve these aims WP5 has been designed around three distinct 'levels' of data collection: documentary analysis; key informant interviews; and clinic fieldwork. We have sought in this design to reflect the relationship between policy and practice in terms of a level of conceptualization (by analysis of various policy and strategy documents), a level of awareness (by interviewing key informants who had a significant stake in, or overview of, current health policies and the policy-making process), and a level of practice (by conducting fieldwork in a series of clinics, reflecting different levels of medical provision). Our purpose has been to link national, regional and local perspectives to provide an up-to-date insight into CVD and diabetes policy, and health services and treatment in one area of each country. These aims and this design are intended to partner the work of MedCHAMPS WPs2-4, and together with these other work packages feed into the analysis to take place in WP6, which follows.

The WP5 report shows that there is a formal recognition about the increased burden of non-communicable diseases in the partner countries. However, they are placed differentially in terms of planning and managing this emerging situation. While Turkey and Tunisia have developed some policies and strategies concerning CVD and Diabetes, Syria is lagging well behind. Despite the unique political context, Palestine is making good progress in this regard.

However, it is also apparent that none of these countries has developed a comprehensive, multi-sectoral, well defined policy to deal with non communicable diseases. The health management system was found to be highly centralized in all the partner countries and there is a lack of coordination between different departments. There is a major lack of information on CVD and Diabetes in all the four countries, as well as a shortage of skilled and specialist health personnel to manage these NCDs. Although the supply of medicine and equipment did not appear as a key problem, there is evidence of unequal distribution between regions, as well as between urban and rural areas. While the degree varies between countries, our research shows that awareness regarding the risks of NCDs among patients is patchy and incomplete everywhere. At the same time, health facilities and treatment processes were generally experienced by patients as unfriendly, with widespread complaints about the time given by health staff to explain the causes and consequences of their condition, and the reasons for the steps stipulated to manage it. Controlling NCDs is a complex challenge and it demands interventions both within and outside the health sector. Each country has come up with specific recommendations to combat these challenges. This report at the end of WP5 is a first stage in analysis of the data collected; publications will follow as our analysis, in individual teams and collectively, develops. We also note that WP5 has played an important part in building research capacity and the skills of qualitative and multi-method research in the partner countries.

11th October - 7th November 2010
The key researchers for Work Package 5 from Syria and Tunisia visited Newcastle to analyse and write the first drafts of their country-specific WP5 Reports, with guidance from Peter Phillimore and Shahaduz Zaman. They spent about four weeks in Newcastle and then continued the write up in their respective countries.

14th-17th September 2010
A qualitative data analysis workshop facilitated by Professor Peter Phillimore and Dr Shahaduz Zaman was held in Istanbul during 14th-17th September 2010. All the key researchers involved in Work Package 5 from four participating countries, including the country leaders, attended the workshop. The main aim of the workshop was to train the participants in purpose and scope of qualitative analysis' to gain practice in doing analysis and reflecting/justifying choices, to identify the initial patterns of the findings and make a preliminary comparison and to discuss the data integration and policy implications. In addition it was aimed to update each other on WP5 progress in each country and to get feedback from the teams on the experience of WP5 data collection.

30th November - 4th December 2009
Researchers from Palestine came to Newcastle University to complete the WP5 training workshop.

3rd-11th October 2009
The first Training Workshop on Qualitative and Ethnographic Research Methods for Work Package 5, was held in Aleppo, Syria, taught by Peter Phillimore and Shahaduz Zaman. Staff from the Syrian, Turkish and Tunisian Partners attended the workshop, whose objective was to to train those researchers who will have responsibility for conducting and organising WP5 in their own country; and to plan the timetable and practical organisation of a programme of data collection with several interlocking parts, and ensure that each of those involved was familiar with the range of research activities entailed.