The need to know / by José R. Ferreira

The Need to Know by Dr Jose R. Ferreira ~ m proving the health of the population as a whole requires the delivery of services based on mastery of already available know- ledge, whether scientific and tech- nical or political, social, and economic. This statement is neces- sarily broad because of the com- plexity represented by the multiple efforts of research, dissemination, and transmission of knowledge, a process which, in the health con- text, has been called "information management". Outcomes and Research The information management process requires countries to take charge, first of all, of diagnosing their own situation and organizing to improve their information sys- tems and their capacity for analysis in overall socio-economic terms, as well as in relation to health care in particular. More specifically, there is a need to strengthen capacity in the areas of analysis of national policy and the financial sector and to probe in depth the factors pro- moting efficiency and efficacy in health interventions in order to bet- ter serve the whole population. Other priorities include biomedi- cal research related to hygiene and public health, as well as studies on nutrition, infectious diseases, en- vironmental protection, and the problems of high risk groups, such as children, women of childbearing age, workers, and the elderly. Re- search in the area of child survival is another priority. Efforts so far have come out of the universities and national re- search institutes charged with fos- tering scientific development. The Pan American Health Organization (PAHO)-the regional office of the This young Central American girl may be the ultimate beneficiary of joint health action by the seven nations of the Central American isthmus. PAHOIWHO Photo by Carlos Gaggero WoRLD HEALTH, October 1987 World Health Organization (wHo)-has pulled together all these initiatives, supporting national in- stitutions and projects in specific fields and developing such multina- tional centers as the Institute of Nutrition of Central America and Panama located in Guatemala, the Caribbean Food and Nutrition Insti- tute in Jamaica, the Pan American Foot and Mouth Disease Center in Rio de Janeiro, the Pan American Zoonosis Center in Buenos Aires, the Pan American Center for Sani- tary Engineering and Environmen- tal Sciences (CEPIS) in Lima, the Latin American Center of Perinatology in Montevideo, and the Caribbean Epidemiological Center in Port of Spain. The Organization's efforts have been concerned mainly with carry- ing out research, as well as lending support to particular projects and training specialized personnel, in- cluding strengthening the capacity to stimulate development of new knowledge and to critically analyze it, always with reference to the actual situation of the country in- volved. A case in point is the cur- rent effort to foster countries' capacities to evaluate new tech- nologies applicable to health care and therapy which are sometimes of disputable value, contributing unnecessarily to the high cost of health care. Data Collection and Dissemination These provisos notwithstanding, essential health information, whether produced in more de- veloped or developing countries, will be useful only to the extent that there are adequate mechanisms for its documentation and dissemina- tion. With exponential growth in the order of 6 to 7 per cent per year, the body of biomedical and health literature and data will dou- ble every 10 or 15 years, providing an immense challenge in terms of information management. The United States, through the National Library of Medicine, has made a landmark contribution in bringing together the largest collec- tion of medical literature in the world and developing an efficient reference system, the Index Medicus. In addition, through the application of modern technology, it has created MEDLARS, a corn~ puterized system for analyzing and retrieving the entire biomedical bibliography. PAHO, with the support of that library and national libraries, has been able to establish a Regional Library of Medicine (BIREME), de- signed to serve all of Latin America, and located in Siio Paulo. This lib- rary, by incorporating the same computerization system, was able to develop a Latin American Index Medicus and create an information network with more than 400 par- ticipating libraries. In addition, two specialized information systems have been created: the Pan Ameri- can Network of Sanitary Engin- eering and Environmental Science Information and Documentation, headquartered at CEPIS in Peru, which represents about 200 centers, and the Latin American Cancer Re- search Project (LACRIP), an inter- national computer network con- cerned with collecting and dis- seminating up-to-date information on cancer. So far these technologies, which permit on-line utilization of inter- national data banks, are accessible only through satellite telecommuni- cations networks, such as is the case with LACRIP, which usually in- volves considerable cost. The Or- ganization is working on an alterna- tive which will initially rely on the facilities of BIREME and CEPIS, eventually going to other general information sources. The new sys- tem uses compact video disks hooked up to a personal computer to gather and manipulate large vol- umes of information and dissemi- nate it cost-effectively throughout the affiliated network. This system 7 A network consisting of more than 1,500 Latin American institutions helps the countries carry out training pro- grams, such as this laboratory course in Trinidad and Tobago. PAHO;WHO Photo by Jul io Vizcarra also offers the advantage of large capacity, since each compact disk may contain the equivalent of one thousand books of 200 pages each. This mechanism is designed to open access tci sources of knowledge, not only to the health library network, but also at the level of health ser- vices and, eventually, to the profes- sional caregiver. In order to facilitate the exchange of information between countries, the language barrier must be over- come. To deal with this situation, PAHO came up with another innova- tive initiative to promote the devel- opment of a computerized English/ Spanish translation system. The process, now in full operation, overcame the dilemma of different 8 interpretations by incorporating a dictionary of phrases which shows the multiple meanings of each word. Transmission and Training The creation of effective informa- tion management mechanisms al- lows the possibility of further trans- mission of this knowledge and of stepped-up staff training efforts. A network has been formed consisting of more than 1,500 Latin American institutions engaged in training pro- grams for 100,000 specialized per- sonnel each year in various health fields. The Organization's efforts range from the promotion of human resource planning and surveys of the health care job market to setting standards of operation for the train- ing network as a whole and lending institutional and program support. The focus has been on promoting the design and establishment of The Need to Know new educational centers, the revi- sion and upgrading of professional courses of study, faculty training, and methods development, along with the collection, production, and distribution of educational material. Professional training is being reor- ganized according to the goal of Health for All by the Year 2000, with an emphasis on the expansion of primary health care. Regarding this educational effort, it should be pointed out that the public health training approach has been adopted by 24 US and 13 Latin American schools of public health, in addition to 16 graduate programs in community and social medicine, as well as several short- term core courses and specialized residencies in health administra- tion. More recently, in Latin Ameri- ca a series of ten Regional Programs of Animal Health Training have been established which combine the resources of public health training centers with those of health care training facilities, reinforcing their strategic planning component. Most of these programs, mindful of the commitment to Health for All, have stressed the need to reor- ganize health delivery systems as well as leadership and advanced training in order to strengthen the decision-making process. Special emphasis has been placed on what has been called "the multidimen- sional focus of epidemiology", which covers not only traditional monitoring and control of infectious diseases, but also everything rela- tive to health analysis and evalua- tion of health services to serve as a basis for health planning and monitoring in all aspects of disease control, both acute and chronic, infectious and degenerative. In this advanced formulation, it is important also to elaborate on in- terdisciplinary relationships in or- der to treat health within its broader social context, considering the implications for other fields in terms of responsibilities and out- comes. Therefore, all aspects need to be considered: educational, ad- ministrative, legal, economic, and political to assure future leaders the knowledge they need to enlarge the dialogue in favor of health develop- ment, reduction of dependency, and promotion of an attitude of confidence and determination to move ahead. • W oRLD HEALTH , October 1987