Funding boost for project working to reduce preventable deaths

Transcript

ALAN LOPEZ: We work in three main areas. One is deaths in hospitals. Now in New Zealand a hundred percent of people die in hospitals. In Papua New Guinea maybe five percent do. So of those people who die in hospitals and that varies in other countries the fraction varies but we should be able to get doctors in hospitals to correctly certify what people die of so that they can be useful for public health purposes. And yet doctors don't either care or have not been trained to do this properly. And so we are using WHO global standards for correctly certifying causes of death to teach doctors in these countries who are trying to get at least the hospital statistics which are known by the system and are treated by qualified medical practitioners to be correctly certified when people die in hospitals. But the vast majority Kori of people in these countries don't die in hospitals. They die in the bush or they die at home. And what we have also done is develop a tool called verbal autopsy where we interview the family of these people. We get we are notified about the deaths and notification systems are generally in place, village headmen or community health-workers and so on. We take those notified deaths and we go into a verbal autopsy interview of the family using tablets and based on the symptoms we have a standardised questionnaire takes 20 minutes to implement. And based on those symptoms we have a very high probability of correctly guessing what the cause of death is. Predicting what the cause of death is. And then we do that on a tablet so there is no pieces of paper moving around and so we use these methodological statistical advances along with IT advances to package the reporting and diagnosing of causes of death based on interviews with the family and then transfer that information to the central statistical office for policy work that is the second area. It is new and exciting and desperately needed. And the third area is we are trying to build up capacity in people to be able to analyse data. Basic data analysis so you have got a data set in front of you how do you analyse it? How do you look for problems? How do you check quality and how do you adjust for that so that you can use the data for policy? People have never taught countries how to do this. And so the University if Melbourne had developed this as part of the programme.

KOROI HAWKINS: And in Papua New Guinea and Solomon Islands in particular given our interest is in the Pacific, what are some of the findings you have come across and have any of those been translated to policy?

AL: Well Solomon Islands is more advanced than PNG and I will speak about PNG in a moment but. In the Solomon Islands we have been working very closely with the government there they are very keen. It is obviously a smaller population but it is no less tractable in the sense that there are populations living in diverse areas on remote islands and we need to cover a representative sample of those at least. And so the government have strongly committed themselves to the strategy that we have been proposing the technical interventions that we have been delivering have been received very well and as a result for the first time ever we have been able to generate with the government. Cause of death statistics admittedly only on a fraction of the deaths in about 20 percent of the deaths that occur in the country [because other deaths are happening outside of hospitals in rural and remote areas] but we have been able to generate cause of death data using our methods which we think are reasonably reliable and those data showed for the first time ever. That it wasn't Measles or Malaria or TB that was killing those people in the Solomon Islands it was heart disease and strokes. And the country was extremely surprised by that and are using these data to change health policy and practices. It will take time these things are not changed overnight but at least now there is the culture of using evidence to inform policy. PNG is less advanced it has been more difficult to work there but what we have found in PNG for examples is that there are several data systems put in place put in by donors and bilateral agreements and those are all generating various statistics of various quality on various diseases and injuries and what we are trying to work with the country is to integrate those to develop a platform to integrate these existing systems and then to strengthen them. It will take a lot longer in PNG but until we have a basis a baseline data system on which we can work and improve. It is very difficult to know where to invest. So going slower but again reasonably, I say reasonably, reasonably committed government support in PNG.

KH: Now I am assuming there is an end date to your work? Or will you be expanding or moving to other countries as you complete?

AL: Very good question Kori and that is what Bloomberg are already starting to discuss with us. The end date is March 31st 2019 that is the end of four years. I have not committed at this stage to do anything more beyond that. I want to see the next six months or so of hard work and see the fruits of our labours. If we have really gotten traction going in these countries as I expect we will and we are already seeing. Then I will be talking to Bloomberg about a phase II of this project. Which would pick up the majority of the current countries. Some of the countries and sites probably won't need our assistance beyond March 2019. I think the majority will and so we would want to continue to work to continue to embed these processes. Continue to agitate and assist countries to use data for public health policy. But we would also like to expand I would be arguing to try to expand that network of 20 to say 25 to 30 including some key countries in the Asia Pacific region.