Today at the United Nations headquarters in New York City, 193 world leaders will commit to 17 Global Goals that will guide economic, social and government policy for the next 15 years. The goals identify issues such as poverty, education, health, climate change and more as major priority areas to focus on in order to achieve sustainable development.

The George Institute for Global Health is a strong supporter and advocate of these Global Goals. Goal Three “Good health and wellbeing: ensure healthy lives and promote wellbeing for all at all ages” aligns very closely with our mission to “improve the health of millions of people worldwide”. At the same time much of our work also upholds Goal Five “Gender equality”, Goal 10 “Reduced inequalities” plus many others.

“These goals provide targets for people, organisations and governments to work towards over the next 15 years,” said Principal Director of The George Institute Professor Robyn Norton. “By committing ourselves to these goals, we can collectively achieve development that is as good for humanity and the environment as it is for business and the economy.”

The Global Goals are an offshoot of the Millennium Development Goals (MDGs), which were launched in 2000 with a target year of 2015.  Recognising the success of the MDGs and that a new development agenda was needed, a number of countries agreed in 2012 at Rio+20, the UN Conference on Sustainable Development, to develop a set of sustainable development goals for beyond 2015.

The George Institute’s work is based on our belief that medical research involves people, not test tubes: our goal is to generate research outputs that can lead to real-world change within a five-year timeframe, rather than the decades-long timeframes of other research fields. Examples of our projects currently underway in India include:

• Reducing road traffic accidents and fatalities
• A worldwide study into the burden of fractures
• Developing a national salt reduction program

“With the new Global Goals focusing on a broader range of health issues than the MDGs, there are substantial opportunities for The George Institute to play an important role in the achievement of these goals,” said Professor Norton, “and we look forward to partnering with colleagues across the world to ensure their success.”

Find out more about the Global Goals.

Recognizing the shortage of public health research professionals in the country, the George Institute for Global Health, India will organize a training program aimed at increasing the research capacity of early and mid-career health researchers with a particular focus on public health research methods.

Called “Clinical Research Training 2015”, this is part of the institution’s overall objective of contributing to the development of public health research capacity in India.

"Given that public health schools are few in India and there is a huge need of public health research, there is a need to develop research capacity amongst clinicians and other health workers, which can impact public health," said Dr Pallab Maulik, Deputy Director and Head of Research and Development at the George Institute for Global Health.

Public health research entails having a comprehensive knowledge about many aspects of research – epidemiology, biostatistics, health economics, and qualitative research, besides specific knowledge about diseases. One need not be an expert in every aspect, but definitely one needs to have basic concepts about each and an awareness of the need for each aspect. For example, a clinician may know his area of expertise, viz.  Mental health but he or she also needs to have an idea about the other core public health research areas outlined above to develop a project in collaboration with key public health specialists.

"The aim of this academic program is to provide that basic, but yet comprehensive awareness about key areas of public health research and is aimed towards clinicians and allied health researchers working in the area of public health," Dr. Maulik added.

The shortage of public health research professionals in this country can be met either by training existing health workers in public health research methods by providing brief outlines and conceptual knowledge about public health research, as is the goal of the training program, or by giving regular formal public health training as part of definite public health degree courses.

The training will run from October 29 to November 2, 2015.  Topics covered in the training include epidemiology, biostatistics, qualitative research, health economics, research funding and management, and career development. There is a fee of Rs. 6,000 to cover the basic costs and the last date for registration is October 11, 2015.  

The teaching faculty for this symposium is comprised of experienced international and local researchers from The George Institute India, The George Institute, Sydney, University of Sydney and the University of Hyderabad.

Attendance of the full symposium will provide participants with a broad practical understanding of key elements of clinical and public health research, as well as some helpful tips on developing a career in these areas. A certificate of completion will be provided to attendees.

Download the Clinical Research Training brochure (PDF 543KB)

In an example of South-South collaboration, researchers from India and China have together discovered cost-effective ways to improve the quality of primary care and clinical outcomes in resource-limited settings which could have major benefits for the general population. 

The study result was recently published in Circulation with an invited editorial.

The simplified cardiovascular management program, also known as the SimCard study, was a one-year cluster-randomized controlled trial carried out in 47 villages in Tibet, China and Haryana, India where access to basic cardiovascular disease (CVD) management and appropriate medications were extremely limited.

The study enrolled 2086 (1,036 in China, 1,050 in India) individuals with high CVD risks, defined as over 40 years old with a self-reported history of CVD and a measured systolic blood pressure over 160mmHg. Community health workers (CHWs) were deployed and trained to manage those individuals with the assistance of an Android smartphone app consisting of a guideline-based but simplified CVD management program.

The combined results found in the study strongly demonstrated the effectiveness of this program in increasing the use of the anti-hypertensive medications, with the primary outcome being a net-difference of 25.5%. In China, a significant decrease in systolic blood pressure (-4.1mmHg) and increase in the proportion of taking aspirin (24.5%) were also observed. No actual lifestyle changes were found in both countries.

The study was carried out in 2011 by The George Institute for Global Health at Peking University Health Science Center (TGI @ PUHSC) in collaboration with Tibet University in China, and the Public Health Foundation of India (PHFI) in India. Larger and longer context-specific trials are needed to further refine the program and evaluate the hard outcomes.

Calling for more south-south collaboration

Despite the differences in the healthcare system, socioeconomic environment and culture, India and China both faced similar challenges in CVD prevention and control such as the rising burden of CVD, large urban-rural health disparities, limited resources and capacity.

Dr. Dorairaj Prabhakaran, Co-Investigator of the study in India and Vice President of PHFI, said that perception was one of the biggest challenges in combating chronic diseases like CVD and needed to be overcome. “People think chronic diseases are only problems for the rich, but we now know, having done this study in poorer settings that hypertension is a big problem. It’s affecting everyone in the population.”

“The study was the first dual-country trial of its kind worldwide and presented a good example for other collaborations between the developing countries in view of the huge synergy recognized and its inexpensiveness and sustainability. We should pool our resources together and collaborate more on areas of common interests in the future.”

Customized community-based intervention

As chronic disease burden has been significantly increased over the past decades, delivery of medical care has also changed from individual to population and community-based healthcare.

“Both population-based and high-risk strategies are needed for prevention and control of chronic diseases like CVD,” said Professor Lijing Yan, Principal Investigator of the study and Honorary Professorial Fellow at TGI @ PUHSC. “In resource-limited settings, it would be highly cost-effective if we could adapt the high-risk approach first and then integrate the strategies recommended by guidelines.”

A simplified ‘2+2’ intervention model, which consisted of two medications (blood pressure lowering agents and aspirin) and two lifestyle modifications (smoking cessation and salt reduction), was developed. The model was based on the international and national clinical guidelines for CVD management so that it can be easily implemented and incorporated into the existing local healthcare system as well.

The interventions were carefully tailored to the local cultures with strong support from local governments. For example, in Tibet, special education was carried out to alleviate concerns among Tibetan patients against western medicines.

The role of community health workers (CHWs)

Professor Yan said this study added to evidence demonstrating the potential effectiveness of CHWs in shifting and sharing the tasks of healthcare professionals, which can help reduce the cost of healthcare for individuals.

“Reliance on the overburdened and relatively small number of specialists to target the high-risk people in these areas is not feasible or sustainable. We need to look at models of care which can be inexpensive, accessible and available to everyone,” said Professor Yan. “CHWs are the key components of carrying out such kind of population-based strategies for CVD prevention and control, and can make things available at the doorstep.”

As a result, although no actual lifestyle changes were found, the intervention was effective in changing both the physician and patients’ behaviors in terms of medication prescription and use, as well as a potential to improve clinical outcomes.

The power of mobile technology

Dr. Maoyi Tian, senior research fellow at TGI @ PUHSC, said the smartphone-based electronic decision support system (EDSS) assisted the CHWs to provide standard and prompt care for the first time in these poorer settings.

“Preliminary results from the study have indicated that the EDSS has a large potential to assist the grass-roots level healthcare providers in clinical decisions and patient management in a highly efficient, cost-effective and time/energy-saving way,” said Dr. Tian.

“When implementing the study, it was also very encouraging to see that the CHWs, no matter whether they were young or senior, were willing and able to use the mobile devices.

“For the next steps, we should harness it and implement it on a larger-scale. We will be keen on improving it to a patient-centered design as well as link with local electronic health record system.” 

Chief Operating Officer of The George Institute for Global Health, Tim Regan, has accompanied Australian delegates to Hyderabad, India, for trade mission talks with Indian officials and business leaders.

The trade mission sought to identify opportunities for greater cooperation and economic partnership between Indian and Australian businesses.

The trade mission involved several high level round tables with delegates including Chief Minister of Andhra Pradesh, Mr. Chandrababu Naidu, and Secretary of Industries, Commerce & Power of Telangana, Mr. Arvind Kumar. The delegation was led by the Parliamentary Secretary to the Minister for Foreign Affairs and the Minister for Trade and Investment, the Hon Steven Ciobo MP.

The trade mission also met with CEO  Ms. Sangita Reddy from Apollo Hospitals and senior executives from Tech Mahindra and the LV Prasad Eye Institute.

Mr. Regan used the opportunity to discuss the importance of enhancing collaboration between Australian and Indian clinical research industries and health professionals, in order to leverage off the expertise of both countries to improve health in the region.  Topics of mutual interest included mHealth and road safety.

“International collaboration is essential to the George Institute mission of improving the health of millions around the world. Trade missions such as these allow for an open dialogue between government, not for profits and businesses to begin to work on these important collaborations,” said Mr. Regan.  

Until a community health worker visited the house of Radha of Lankalakoderu village, neither she nor her family members suspected that she was at high risk of cardio-vascular disease. Shyamala, the Accredited Social Health Activist (ASHA) of the village had been going from house to house with a smartphonebased application devised by the George Institute for Global Health that allowed her to screen individuals with high risk of getting heart disease as part of a project called the SMARThealth project. After a few simple questions, taking her weight and measuring her blood pressure, she told the 60-year old that her blood pressure was very high, she was at high risk of having a cardiovascular event and so must visit the primary care doctor immediately.

Dr. Sowjanya, medical officer at the Lankalakoderu Primary Health Care centre saw her in February this year after her regular consultation hours in a special Cardio-Vascular Disease (CVD) clinic that she runs every month as part of the project. She had another tablet with a different version of the SMARThealth app (meant for doctors). She was able to quickly confirm Radha’s high risk status and put her on medication immediately. Assisted by regular prompts from the app, the ASHA worker has been following her up regularly and Radha has made three visits to the doctor since then. The app generates alerts for the ASHA worker and is able to send messages to patients’ phones as well. The result is that Radha’s blood pressure  is under control now, and her risk status has improved.

This unique project involving screening of  high risk cardiovascular cases followed by consultation with a doctor either at special CVD clinic in the village or at regular PHC center is currently being run in 36 villages as part of a community randomized control trial that is designed to test the effectiveness of this task-sharing mechanism enabled by technology. ``The idea is to deliver good quality affordable health care to as many people as possible by  empowering community health workers with the tool that can help them identify high risk patients and then refer them to the doctor,’’ says  Dr. David Peiris, Head of Primary Health Care Research at the George Institute for Global Health, Sydney.

Dr. Sowjanya has seen 200 patients at high risk of cardio-vascular disease so far which she would not have been able to do in her normal course at the Primary Health Care Centre. ``We need this kind of focus and I am happy to be a part of this project,’’ she says, adding that patients whom she has seen two to three times are actually showing good results.

The doctor prescribes simple blood pressure medicines after verifying the risk category of  each and every individual.  ``The real challenge we face is the availability of all kind of medicines at the primary health care centre,’’ she adds.

The project that had started in six PHCs in West Godavari district  six months ago is now being extended to six more PHCs. In the final phase, we will be adding six more, says Dr Praveen Devarasetty, Program Head – Primary Health Care at the George Institute for Global Health-India. "This will ultimately help us compare the results in all the villages over time periods when they were part of the project and when they were not,’’ adds Dr Praveen.

This large community-based randomized control intervention is seeking to prove two things. Firstly, that community health workers can work as frontline personnel in a task-sharing mode and that technology can help them do the screening effectively, and second, that doctors can be assisted by an electronic-decision support system in tackling the burden of CVDs in rural areas. ``we call it SMART for Systematic Medical Appraisal, Referral and Treatment,’’ says Praveen, adding that the plan is to systematically extend the framework to other diseases.

ASHA workers are happy to be a part of the project. ``I have referred a large number of   high risk cases from my village to the doctor and am following them up regularly. It makes me happy to see that people are actually seeing their blood pressure coming down and the doctors are also placing a great deal of confidence in us,’’ says Devi Reddy of Juvalapalem village,  one of the ASHA workers involved in the project.

Arguing that SMARThealth shows the way for transformational health care delivery in a country where there is only one doctor per 30,000 population in rural areas, Dr. Vivekanand Jha, Executive Director of the George Institute for Global Health-India, says: "We are already extending SMARThealth to the field of mental health and diabetes and by spearheading such transformational research, we hope to play a significant part in reducing premature deaths and disability in the country.’’ 

Dr Praveen Devarsetty, Senior Research Fellow at The George Institute for Global Health India, has been featured for his research into how mHealth technology can be used as a low cost, high impact healthcare tool in the latest Global Alliance for Chronic Diseases Annual Report.

Dr Devarsetty said that his most recent project, SMARThealth has the capacity to transform health care by providing high quality care at a low cost.

“This is only possible if the mobile technology is properly harnessed and well integrated within the existing health care delivery system strengthening the existing services and filling the gaps.

“Despite a number of studies demonstrating the usability of mHealth applications, the current evidence base is insufficient to guide decisions on policy and practice.”

Dr Devarsetty said the strategy was well accepted by the end users i.e. villagers, non-physician health care workers and doctors as demonstrated in the pilot.

“It increased the opportunities for people within the community to get screened and managed by the public health care facilities.”

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