Evidencebased Health Care and Consumer Involvement in Developing Countries: Challenges and Opportuni

1
Evidence-based Health Care and Consumer
Involvement in Developing Countries Challenges
and Opportunities

• Godwin N. Aja, MCH, CHES
• Department of Health Sciences
• Babcock University
• Ilishan-Remo, Ogun State, Nigeria
• A Consumer Workshop Presentation at the African
  Cochrane Contributors Meeting organized by the
  South African Cochrane Centre, May 22-29, 2007 at
  the South African Medical and Research Council
  Conference Centre, Cape Town, Republic of South
  Africa

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Wake Up Call

• It is certainly expedient for developing
  countries consumers to contribute in the search
  for and development of evidence for quality
  assurance.

3
Food for Thought

• Whats a good review good for without a
  consumer?
• (Cochrane Consumer Network Newsletter, Issue 8,
  December 2004)

4
Cochrane Consumer Definition

• An individual who has unique personal experiences
  that allow him or her to provide an effective
  healthcare user/receiver perspective to a
  systematic review question.
• An individual or a representative of a community
  health support organization or group and is
  generally without specialist medical knowledge.
• The term, consumer, is used more broadly than for
  patients actively under treatment.

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Cochrane Consumer Network (CCNet)

• Links and coordinates consumer input in the work
  of The Cochrane Collaboration.
• Empowers consumers by providing training,
  support, and multilevel communication.
• Supports and coordinates consumers working within
  The Collaboration, enabling effective, open
  communication.
• Empowers consumers involved within The Cochrane
  Collaboration to inform other consumers of the
  value of systematic reviews.
• CCNET provides consumer input into developing
  Cochrane
• systematic reviews of best evidence in health
  care and in
• utilizing this evidence.
• www.cochrane.org/consumers

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The Cochrane Collaboration Structure and Consumers
Collaborative Review Groups
Centres
Steering Group
Methods Groups
Fields
The Consumer Network
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CCNet Who we are

• Equal partners in the search for evidence
• Key stakeholders
• An entity of The Cochrane Collaboration
• A Field within the Collaboration (works with more
  than one entity)

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CCNet What we offer

• Identifying questions that are important to
  consumers
• Commenting on Cochrane reviews
• Disseminating results
• Raising awareness of the importance of systematic
  reviews
• Handsearching healthcare journals
• Contributing to writing lay summaries of
  systematic reviews
• Maintaining an e-mail discussion list and a
  website
• Producing newsletters and disseminating
  information, including from reviews
• Providing links between consumers and relevant
  Cochrane entities
• Organizing workshops
• Representing the views of consumers both inside
  and external to the Collaboration

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CCNet What we offer

• Translating materials
• Recruiting other consumers
• Being a consumer editor
• Being an author of a review (or part of a team)
• Fundraising
• Being a consumer representative on Cochrane
  advisory groups and the Cochrane Collaboration
  Steering Group

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CCNet How we work

• More than 300 members From Australia/New
  Zealand United Kingdom/Europe Africa
  USA/Canada Asia/Pacific Latin America Middle
  East.
• The Cochrane Collaboration itself has Centres and
  Branches in over 23 different countries.
• The Convenor coordinates the activities of the
  Network and strives to strengthen the role of
  consumers in the Collaboration and outside
• Supported by an Administrator in organizing and
  supporting our membership
• An international Governance Council (Coordinating
  Team) is charged with ensuring equitable
  opportunity for consumer members and good
  governance.
• Two representatives on The Cochrane Collaboration
  Steering Group
• Operates principally via the internet (regional
  meetings and the annual Cochrane Colloquium
  provides an opportunity to meet)

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CCNet How we work

• To contact the Cochrane Consumer Network, send an
  e-mail to
• ccnet-contact_at_cochrane.de with your name and
  enquiry
• To find out more about CCNet, go to
• www.cochrane.org/consumers

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Current Stages of Consumer Involvement in
Developing Countries

• Precontemplators No idea that EBHC exists.
• Contemplators EBHC exists but no commitment.
• Preparators Intending to take action soon.
• Actors Considerable commitment of time and
  energy
• Maintainers Super commitment (in consumer
  recruitment, training, support, etc).
• (Prochaska)

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Recruiting developing countries consumers
Challenges

• Language of evidence (medical science) -
  technical
• Practitioners of evidence (medical science)
  sophisticated (medical distance)
• Paternalism not partnership
• Technology gap so wide
• Resources (time commitment vs. volunteerism) -
  limited
• Past experiences - inhibitive
• Culture - different

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Recruiting developing countries consumers
Opportunities

• CCNet a rallying point
• Partnership with local community leaders/consumer
  organizations
• Partnership with religious groups
• Institute awards/incentives on consumer
  participation at local, provincial and national
  levels
• Developing Countries Network

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Conclusions

• Developing countries consumers cannot afford to
  remain spectators in the search and push for
  evidence anymore.
• Involvement means that the needs and preferences
  of the consumer are defined and not denied.
• CCNet is the spring board for developing
  countries consumers.
• The evidence in evidence-based health care may be
  much more evident as more consumers get actively
  involved in the production and dissemination of
  evidence.

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Group Discussion

• How can we overcome the challenges?
• How can we harness the opportunities?
• Whats in a name? Consumers, users, patients,
  civil society, etc?