Hospital management information systems (HMIS) is a key component of national health information systems (HIS), and actions required of hospital management to support information generation in Kenya are articulated in specific policy documents. The authors evaluated core functions of data generation and reporting within hospitals in Kenya to facilitate interpretation of national reports and to provide guidance on key areas requiring improvement to support data use in decision making. Study findings indicated that the HMIS does not deliver quality data. Significant constraints exist in data quality assurance, supervisory support, data infrastructure in respect to information and communications technology application, human resources, financial resources, and integration.
Monitoring equity and research policy
In their adoption of WHA resolution 69.19, World Health Organization Member States requested all bilateral and multilateral initiatives to conduct impact assessments of their human resources for health funding. No standard tools exist for assessing the impact of global health initiatives on the health workforce, but tools exist from other fields. This paper describes how a review of grey literature informed the development of a draft health workforce impact assessment tool and how to introduce the tool. A search of grey literature yielded 72 examples of impact assessment tools and guidance from a wide variety of fields including gender, health and human rights. These examples were reviewed, and information relevant to the development of a health workforce impact assessment was extracted from them using an inductive process. A number of good practice principles were identified from the review. These informed the development of a draft health workforce impact assessment tool, based on an established health labour market framework. The tool consists of a relatively short and focused screening module to be applied to all relevant initiatives, followed by a more in-depth assessment to be applied only to initiatives for which the screening module indicates that significant implications for HRH are anticipated. It thus aims to strike a balance between maximizing rigour and minimising administrative burden. The authors propose that the new tool will help to ensure that health workforce implications are incorporated into global health decision-making processes from the outset and to enhance positive human resources for health impacts and avoid, minimise or offset negative impacts.
This paper assessed, whether and how, two knowledge translation platforms housed in government-affiliated institutions in Cameroon and Uganda have influenced health system policy-making processes and decisions aiming at supporting achievement of the health millennium development goals and the general climate for evidence-informed health system policy-making. The authors conducted an embedded comparative case study of four policy processes in which Evidence Informed Policy Network Cameroon and Regional East African Community Health Policy Initiative Uganda were involved between 2009 and 2011. The authors combined a documentary review and semi structured interviews of 54 stakeholders. A framework-guided thematic analysis, inspired by scholarship in health policy analysis and knowledge utilization was used. The coproduction of evidence briefs combined with tacit knowledge gathered during inclusive evidence-informed stakeholder dialogues helped to reframe health system problems, unveil sources of conflicts, open grounds for consensus and align viable and affordable options for achieving the health millennium development goals thus leading to decisions. New policy issue networks have emerged. Knowledge translation platforms were perceived as change agents with positive impact on the understanding, acceptance and adoption of evidence-informed health system policy-making because of their complementary work in relation to capacity building, rapid evidence syntheses and clearinghouse of policy-relevant evidence. The authors indicate that this embedded case study illustrates how two knowledge translation platforms influenced policy decisions through pathways involving policy issue networks, interest groups interaction and evidence-supported ideas and how they influenced the general climate for evidence-informed health system policy.
This paper examines some recent yardsticks used to sort the evidential sheep from the research goats by questioning why, how and when such research standards should be brought to bear. It concludes that the drive to cast standards as formal checklists of quality indicators is premature, and that appraising quality is not and cannot be a technical preliminary to research synthesis. Open and critical debate on the interpretation of research findings remains the surest way to establish and maintain investigatory standards.
Monitoring and evaluation of national antiretroviral therapy (ART) programs is vital, but routine, standardized assessment of national ART patient monitoring systems has not been established. Malawi has undertaken an ambitious ART scale-up effort, with over 57 000 patients initiated on ART by June 2006. This paper reports on an assessment of the national ART monitoring and evaluation system in Malawi to ensure that the response to the epidemic was being monitored efficiently and effectively, and that data collected were useful. It propoises that assessment of ART monitoring and evaluation systems can optimize the effectiveness of national ART programs, and should be considered in other resource-constrained countries rapidly scaling up ART.
Health systems constraints are impeding the implementation of major global initiatives for health and the attainment of the Millennium Development Goals (MDGs). Research could contribute to overcoming these barriers. An independent task force has been convened by WHO to suggest areas where international collaborative research could help to generate the knowledge necessary to improve health systems. Suggested topics encompass financial and human resources, organisation and delivery of health services, governance, stewardship, knowledge management, and global influences. This article from The Lancet medical journal is part of a wide-ranging consultation and comment is invited. (Registration is required to access this article.)
Strengthening health research capacity in low- and middle-income countries remains a major policy goal. The Health Research Capacity Strengthening (HRCS) Global Learning (HGL) program of work documented experiences of HRCS across sub-Saharan Africa. The authors reviewed findings from HGL case studies and reflective papers regarding the dynamics of HRCS. Analysis was structured with respect to common challenges in such work, identified through a multi-dimensional scaling analysis of responses from 37 participants at the concluding symposium of the program of work. Symposium participants identified 10 distinct clusters of challenges: engaging researchers, policymakers, and donors; securing trust and cooperation; finding common interest; securing long-term funding; establishing sustainable models of capacity strengthening; ensuring Southern ownership; accommodating local health system priorities and constraints; addressing disincentives for academic engagement; establishing and retaining research teams; and sustaining mentorship and institutional support. Analysis links these challenges to three key and potentially competing drivers of the political economy of health research: an enduring model of independent researchers and research leaders, the globalisation of knowledge and the linked mobility of (elite) individuals, and institutionalisation of research within universities and research centres and, increasingly, national research and development agendas. The authors identify tensions between efforts to embrace the global ‘Community of Science’ and the promotion and protection of national and institutional agendas in an unequal global health research environment. A nuanced understanding of the dynamics and implications of the uneven global health research landscape is required, along with a willingness to explore pragmatic models that seek to balance these competing drivers.
Adopted on 19 November – the final day of the Global Ministerial Forum on Research for Health hosted by the government of Mali in Bamako – the Call to Action urges national governments to allocate at least 2% of budgets of ministries of health to research. In parallel, funders of research and innovation, together with international development agencies, are urged to invest at least 5% of development assistance funds earmarked for the health sector in research, according to recipient country-led research strategies, instead of allowing the current situation to continue, where donor countries push their own agendas, thus shaping the agenda on behalf of recipient countries. The signatories have called for greater equity by increasing spending on researching the health challenges that disproportionately affect the poor, marginalised and disadvantaged.
An important focus of the Bamako Call to Action was to ensure that research priorities were determined by countries, not global institutions. To this end, the multilateral contributors to Bamako – WHO, UNESCO and the World Bank – were asked to promote, expand and implement research strategies with an emphasis on listening to country agendas and responding to their priorities. The idea of 18 November as an annual World Day of Research for Health was proposed as one means to maintain attention on this lever for health improvement. The Call to Action will now go to WHO’s Executive Board in January 2009, where they will do their utmost to ensure implementation of these urgent country requests. 2009 needs to be a year of action, not empty promises.
Progress since the last WHO ministerial summit in Mexico in 2004 is not striking, though there is the clinical trials platform, as well as new initiatives for knowledge translation networks like EVIDnet, and other local and regional projects that have achieved fragmented success. The Mexico declaration called for health ministries to dedicate at least 2% of their budgets to research. For most developing countries this remains an aspiration, with most still well below 1%. The problem is that research is a hard thing to sell where resources are tight. Convincing the public that research is not a luxury can be difficult. Hopefully, by the next ministerial summit in 2012, the discussion will no longer be about research for the world’s poorest nations but research by them for themselves. But, sadly, it seems all too possible that four years from now participants will be having exactly the same conversations.