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Institutional Assessment of Health Research Capacity in Uzbekistan

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Institutional Assessment of Health Research Capacity in Uzbekistan Institutional Assessment of Health Research Capacity in Uzbekistan Research Productivity, Organizational Capacity and Research use in Policy Inaugural-Dissertation zur Erlangung der Doktorwürde der Philosophischen Fakultät der Rheinischen Friedrich-Wilhelms-Universität zu Bonn vorgelegt von Minjung Cho aus Seoul, Südkorea Bonn, 2018 Gedruckt mit der Genehmigung der Philosophischen Fakultät der Rheinischen Friedrich- Wilhelms-Universität Bonn Zusammensetzung der Prüfungskommission Prof. Dr. Christoph Antweiler, Institut für Orient- und Asienwissenschaften (Vorsitzende/Vorsitzender) Prof. Dr. Solvay Gerke Zentrum für Entwicklungsforschung (ZEF) (Betreuerin/Betreuer und Gutachterin/Gutachter) Prof. Dr. Stephan Conermann, Institut für Orient- und Asienwissenschaften (Gutachterin/Gutachter) Prof. Dr. Conrad Schetter, (BICC) Bonn International Center for Conversion (weiteres prüfungsberechtigtes Mitglied) Tag der mündlichen Prüfung: 09.11.2017 ii Abstract Health research continues to be an important policy instrument in improving population’s health and building a more resilient health system. As developing countries are unable to meet their national health-research needs, many foreign aid actors have concentrated on improving health research system (HRS) of low-income countries since 1990s. While there is growing interest, there is a gap in the literatures in understanding health research system in the framework of institutions and its actors in a developing country context, which affects the knowledge production and research performance. In light of this argument, the thesis focuses on Uzbekistan. Uzbekistan was ranked as one of the lowest health research producers in the world in 2016. This raises the following question: Has post-soviet political and economic transition brought changes to health research system in Uzbekistan? If so, what was the outcome of change from these reform pressures? To answer this question, this thesis combines elements of neo-institutional theories to analyze the processes of institutional modification in health research system over the past twenty years in Uzbekistan. The results from both quantitative and qualitative analysis revealed that the slow progress in any institutional change in the health sector was due to path dependent traits dating back to more than 60 years of Soviet science management. Basic incentive structures or forced regulatory reforms, which reinforce path-dependent behavior, often failed to create significant change in Uzbek health research performance. Further analysis revealed that causes of (under)performance in Uzbek health research system are complex and deeply rooted, reaching beyond the current circumstances and resources. The institutionalist approach proved useful in understanding transformations in post-soviet countries taking into account the particularities of local/national research institutions. iii List of work submitted to international conferences and awards received No Name of the conference Type of Date /Venue Title of work Specifics work accepted 1 American Society of Poster Nov. 13-17, Understanding Related to Tropical Medicine and presentation 2016/Atlanta, research chapter 5 Hygiene 65th Annual Georgia, activity in the Meeting USA health sector of Uzbekistan: Implications for health research capacity strengthening 2 5th World Research Doctoral May 28, Institutional Best Integrity Conference Forum 2017/ assessment of Dissertation Amsterdam, Health Award Oral Netherlands Research st presentation Capacity in (1 prize) Uzbekistan: Related to Productivity, chapter 5 Organizational and 7 Capacity and Research Translation 3 5th World Research Poster May 29-31, Critical Related to Integrity Conference presentation 2017/ Evaluation of chapter 5 Amsterdam, health and 6 Netherlands research publication activity in Uzbekistan iv Acknowledgements This thesis would not have been possible without the guidance and the support from many individuals and organizations. My deepest thanks must go to my supervisor, Prof. Dr. Solvay Gerke and my tutor Dr.Subramanian Saravanan, for guiding me through the PhD process. I am especially indebted to Dr. Subramanian Saravanan, the coordinator of the Center for Development Research (ZEF)/Health Research Capacity and Water Related Diseases (HEALTHCAP) project for his kind-heartedness, critical insights, and his amazing academic guidance throughout my research progress. I would also like to acknowledge VolkswagenStiftung (no.86895) for their support in funding this study under the scope of the HEALTHCAP project. I would like to extend my appreciation to all the senior and junior researchers at the ZEF Department of Political and Cultural Change for the exchange of knowledge through periodical colloquia and ad hoc meetings. My study in Bonn would not have been possible without the administrative support from Dr. Günther Manske, Ms Maike Retat-Amin and other staff members at ZEF who I am deeply grateful for. I would like to express my deepest gratitude to my ZEF batch 2014 for their loving support and solidarity. I would personally like to acknowledge our dear friend Maria, our loving friend, who will always be in our hearts. My sincere thanks goes to Dr. Mohir Ahmedov for his support and advice in conducting research in Uzbekistan. I would like to extend my thanks to the research assistants during the field work –Marguba and Aziza- for helping me with the interviews with the local participants. My appreciation also goes to Fotima, Nargiza, and Iroda among others for their support during the HEALTHCAP project. My gratitude also goes to all the project partners of HEALTHCAP project. I would also like to thank Dr. Song Young Hwa and Inessa for their input and support to identify and connect with potential research participants. I am very grateful to all the research participants, especially the senior government officials, parliamentary members, and researchers of Uzbekistan for their time and frank deliberations. Finally, I want to express my deepest appreciation to my dear parents and friends, for their endless love and support during my PhD journey. I would like to give a special shout out to CCCB for being there by my side through good and bad times, for the interesting academic debates, and for being awesome. v Table of Contents Zusammensetzung der Prüfungskommission .................................................................. ii Abstract .......................................................................................................................... iii List of work submitted to international conferences and awards received ....................... iv Acknowledgements ......................................................................................................... v Table of Contents ........................................................................................................... vi List of Tables ................................................................................................................. viii List of Figures.................................................................................................................. x List of Acronyms ............................................................................................................ xii Chapter 1. Introduction ........................................................................................... 13 1.1. Understanding the health research system ........................................................... 13 1.2. Concepts and definitions ...................................................................................... 15 1.3. Contribution and limitations of the study ............................................................... 25 Chapter 2. Theoretical Framework ......................................................................... 29 2.1. Examining health research systems through new institutionalism theory .............. 29 2.2. Main types of neo-institutionalism theory .............................................................. 31 2.3. Analytical framework - Analyzing Institutional change within Uzbekistan health research system ......................................................................................... 43 2.4. Conclusion ............................................................................................................ 47 Chapter 3. Methodology .......................................................................................... 51 3.1. Introduction ........................................................................................................... 51 3.2. Methodological Paradigms to Assess Health Research in Uzbekistan .................. 53 3.3. The mixed methods approach .............................................................................. 61 3.4. Putting it all together: Linking theory and data ...................................................... 79 3.5. Conclusion ............................................................................................................ 80 Chapter 4. Complexity of Assessing the Health Research Capacity in Uzbekistan ............................................................................................. 81 4.1. Historical trajectory on political economy, education, research and development (R&D) , and health sector in Uzbekistan .......................................... 82 4.2. Discussion ............................................................................................................ 98 4.3.
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