Steps in health research proposal development

Proposal is a suggestion or intension, especially one puts forward formally or officially. Proposal in the health research mean different in different categories of people. It is a marketing document to an investor, it is a legal and binding document to a PI and an investor. Above all it is a document that states the purpose and the content of study to be performed by an investigator. The proposal document consists of the plans and the goals of a research programme and also the willingness and acceptability of the investigator or institution towards such plans to achieve the goal proposed.

                There are different types of proposals such as letter/concept proposal and full proposal. Unsolicited or non-pleading proposal is to be first written in the form of letter proposal, than only will it be forwarded for further evaluation. The letter proposals are developed into full proposals only after it has been approved by the donors, may it be national or international, private or governmental. The letter proposal comprises of the preliminary interest to an investor. Full proposals are often request for proposal (RFP).

                There are certain formats that have to be fulfilled in health research proposal writing. According to Nepal health and research council (NHRC) five steps or parts to be cleared in the writing of a proposal. The 5 steps are:

                Part 1- Administrative data sheet

Part 2- Financial data sheet

Part3- Research proposal description sheet

Part4- Ethical considerations

Part5- Annexes

               There are certain steps that are to be followed in writing a health research proposal. The steps are multiple so as to ease the pathway toward the goal of the research programme. The steps that are to be considered while starting the thought of a research or writing a proposal are: question you must ask, steps you will take, important elements, information that is already available, literature review, literature and other available information, additional data needed and the way to acquire it, research methodology, resource, budget plan and personal timeline. Each step that are to be followed in health research proposal development is truly very important due to the fact that these are the steps that determine the credibility of the investor and the institute that are initiating the research plan.  The steps are to be followed in writing the proposal to the health research since each step mentioned has a significance in itself. Some of the significance are mentioned as follows:

                -Question you may ask—What is the problem and why should it be studied?

-What information is already available—Why to research and what to expect to achieve?

-Literature review—Formulation of objectives and no duplication of previous papers.

                The main reason a proposal fails is that the people do not follow the certain steps that are required to be fulfil while writing the proposal. The steps if followed attentively will allow a good proposal to be written due to the fact that it covers all the aspects of a health research protocol that are to be followed not only in the paper but also in the practicality of the research scenario. Looking into some of the causes of failure of the proposal like lack of familiarity with funding organization and need; which can be covered by looking into the budget plan as well as the logistics available, study or topic not a priority to the funder or duplication of previous studies; which can be covered by looking into the literature and available information, no consistency in different components of proposal and so on.

                Therefore for a good proposal to be written the investigator and the investor as well have to have a good knowledge about what a proposal is, what are the types of proposals, what are the formats that have been lead forward by the NHRC and most importantly what are the steps that are to be met while writing a proposal.

 

Fundamentals of health system research in Nepal

                Viewing the latter three words in the topic mentioned above we can see three different words that are compiled together to produce one statement. There are different meanings to health, system and research. Health as we all know is ‘ state of complete physical, mental and social well being and not merely the absence of disease processes’ according to World health organization in the year 1948. System is the collaboration of different fields working in a constellation so as to accomplish an activity, task or work; to reach a certain goal. For example when people built a house there is collaboration of not only the workers but also the engineer, the owner and many more which is in itself a system. The third word is ‘research’ which is systematic collection, analysis and interpretation of data to answer certain question or solve some objectives in any fields (health, economy, physics, biology etc).

                Talking about the health system, as we already know the meaning of the words, we can interpretate it as the collaboration of different fields working in a constellation so as to accomplish certain task in the sector of health. The system comprises not only of doctors and nurses as most of us think; but it comprises of multiple different aspects so as to maintain the health of people of a country. The system comprises of multiple factors such as socio-economic, political, cultural, physical epidemiological and so on, without which the health system would collapse. The components within the system of health are folk medicine, private practice, pharmaceuticals, health services at different levels, education, sanitation, food and so forth. Now, we have come to know that health system not only focuses on the disease or infirmity but also focuses on different aspect that can lead to deviation from normal physical, mental and social wellbeing. So, for the development of health in the country, the government has to focus not only on hospitals or clinics but also on the other sectors.

                Knowing about what the health sector is, we now focus on health system research. Health system research is the systematic collection, analysis and interpretation of data to answer certain questions or accomplish some objective in the field of health system. Since the primary intent of health system is to promote good health, the research on health system focuses on what can be done to improvise the system of health so that in return the health system provides good health services to promote health in the people of the country. Right now according to research the health system of Nepal is facing challenges such as external dependency of finance, political instability, retention of health force in the urban area of the country etc. The government of the country now can focus on how to eliminate these obstacles and move forward so as to upgrade the health system. This can be done only if the interaction of health sector and non-health sector is established. Non health sector as we already mentioned above can comprise of politics, education, sanitation, socio-economical stability and so on.

                  Now the question arises how the faults in the health system can be lifted so as to promote health in the country? This is why the term ‘Health system research’ exists. In the health system research there are multiple aspects that has to be looked upon.  The purpose of health system research is to build up and inform about policy, manage  professional practices so as to empower decision-makers to improve  health & well-being of people through optimal use of resources and opportunities. This in implemented in the context of complexities of health sector issue, policy and programme.

                Thus, to build, smooth and advanced health sector in the country the process of Health system research is very important. It is due to the fact that it allows the government and the professionals of health care to act upon the different aspect of health system sectors as well as the health sectors to improvise and maintain the health of the people of the country. 

An overview of Nepal Health Research Council

Nepal research health council (NHRC) is a part of Ministry of health (MOH) which deals wholly with research aspect in the health sector of Nepal. Production and implementation of policies for research activities, to give consent for research purpose, to direct the research work, to give authenticity to the research performed, to provide financial help for the research activities are some of the functions of NHRC.

                NHRC  was established in 1991 A.D as a statutory and autonomous body. The part of ministry of health was established so as to study and research the problems being encountered in the health sector not only in the country but internationally as well. NHRC also acquires the information about the studies, research and works being performed in the country by the government, private sector or international organizations. Research work in Nepal cannot be performed in Nepal until the consent of NHRC. If any person or organization performs research work on their own and does not seek the permission of NHRC  pursuant to section 11 or if the person or organization does not abide by the terms and condition mentioned shall be prohibited to carry out any research for a specified time period.

                There are overall 13 members employed by the government of Nepal a member in NHRC. The members come from different fields in the government sector of Nepal. Seven of the members are appointed by Nepal Government from among the physicians of modern medical system and ayurvedic medical system having experience in the study and research relating to health (including Chairman & Vice Chairman). Other members are, one each from ministry of finance, national planning commission, ministry of health and population, chief of research committee (institute of medicine), chairman of Nepal medical council and a person appointed by the Nepal government.

                The grants given in the sector of research is provided from multiple sources. Government of Nepal, international government or organization, amount received from consultancy service and research work are some of the source that finance the research activities in Nepal.

                There are multiple publications like ethical guidelines, annual reports, journals, training manual and books from the NHRC so as to direct the research work according to the terms and conditions implemented by the government and publish the outstanding research works in the journals of NHRC. 

                There are multiple activities that are performed by NHRC so as to enhance capacity of researcher, enhance knowledge and skills of participants and to familiarize the participants in health research process in Nepal. The activities are like training, dissemination workshop and documentation and networking.

                In a nutshell the government of Nepal established the part of MOH as NHRC so as to enhance the productivity and to improvise the health sector in Nepal.

Tiotropium vs Salmeterol ( footage from nejm)

Treatment have been advised for acute exacerbation of COPD, which are either anti-cholinergics ( e.g. Tiotropium) or beta-agonist (e.g Salmeterol) both long acting. It had not been advised which was the preferred drug. Multiple hospitals participated in research as to which of the above drug was better in terms of alleviation of symptoms and reduction of the risk of acute exacerbation of COAD. The results of the research shows that Tiotropium has better effects than Salmeterol .

     7376 patiens were assigned, out of which 3707 patients were on Tiotropium and 3669 patients were on salmeterol. Tiotropium reduced the risk by 17% as compared to Salmeterol. Incidence of adverse effect and events leading to discontinuation of the drug was the same in both the drugs. There were 64 deaths in Tiotropium group and 78 deats in salmeterol group.

   For further reading please consult new England journal of medicine.

Prophylaxis of elephantiasis in Nepal

The government of Nepal had started a programme for prophylaxis of elephantiasis in Nepal some wks ago. The drug which was being used has caused a massive morbidity in the palaces where the programme was being implicated. The places like Nepaljung and Veri are the main site where the programme was benig conducted. There has so far been around 2-3 deaths and >500 people are ill due to the side effects of the drug being used. Government has employed two doctors for the investigation of the illness. They have been sent to the areas so as to investigate if the cause of the illness is the drug or there are any other causes. The mortality is seen among the extremes of age group ( two kids of age 8 and 12; an old man of age 85). There also is reported an old man of age 65 who is so severe that he is in the verge of life and death.
    The symptom starts around a day or 2 of consumption of the drug. The symptoms are diarrhoea, fever, headache etc. The government has not yet published the epidemiological datas and census.

Prevalence in Nepal

- The overall prevalence of lymphatic filariasis from a 4,488-sample population was 13% and 33/37 districts were found to be endemic.

- On the basis of geographical data, the highest number of cases was found at altitudes between 500–700 m.

For the control of filarial worm in a community the drugs that can be used are:

             1. Diethylcarbamazine (DEC) 6 mg/kg body wt/ day for 12 days

             2. Ivermectin

                                                                           




                                                         Fig. Loa Loa filarial worm

Dr. Camillo golgi

Doctor Camillo golgi was an italian histologist. The thing that are named after him are:

1. Golgi apparatus- Cell organelle
2. Golgi cycle- Life cycle of malarial parasite
3. Silver golgi stain- for nervous tissue
4. Inhibitory golgi cells in the cerebellum
5. Golgi remnant in the spermatid 

MATERNAL MORTALITY

I JUST WANT TO SAY ONE THING TODAY. NEPAL IS 1ST ON MATERNAL MORTALITY RATE. THE OTHER FACT IS THAT, EACH MINUTE AROUND 4 WOMEN DIE OF MATERNAL MISHAPS ALL AROUND THE WORLD. 

Hello people

This blog which I have started is for all the people who are not satisfied by the diagnosis or treatment of the physicians. I know that there are people out there who want a second opinion about the conditions they suffer from. So, I am here to help you out. I am a board certified doctor. If you have faith in me than you will be healed mentally as well as physically, this is my promise. This is also a site opened for the medical students and doctors who are curious about the facts about any field of medicine, surgery, obstetrics and gynecology and so on. Please help yourself. Thank you and welcome.