Health Impact Assessment (HIA) advances Health in All Policies by identifying impacts of proposed actions on health and equity and recommending changes to address these impacts. Since the Gothenburg Consensus Statement in 1999, HIA has been applied to policies, plans, programmes and projects in multiple sectors and settings across the world. Despite demonstrated effectiveness, its use across the world is inconsistent with few nations systematically using HIA. In a global context of increasing health inequities, pandemics, climate change, and economic crises, HIA can help integrate health and equity into decision making. There is a need for research to support the ongoing evolution and development of HIA. This paper presents a research agenda for the field of HIA, drawn a mixed method approach utilising insights of approximately 280 participants through an international online survey and participatory workshops. The authors identified four research priorities: (1) Institutionalisation - Sustaining and institutionalising HIA in varying contexts and levels. (2) Influence - Identifying mechanisms and strategies that can be employed to effectively influence stakeholders and decision making. (3) Equity and Participation - Analysing the role of equity, justice, power and participation in HIA, and (4) Methodology - Improving HIA Methods to understand the complex relationships between proposed actions, health and health equity outcomes and identifying what to do. We developed research questions for each theme. The research agenda advocates for sustained research and practice to strengthen impact and address knowledge gaps in the field. Functioning as a roadmap for both researchers and funders, it aims to contribute to a healthier and more equitable world. Recognising the valuable role of HIA in addressing global health challenges, the agenda encourages researchers to investigate, develop, and advance the field of HIA.
Monitoring equity and research policy
Health Impact Assessment (HIA) provides a practical set of tools to appraise the potential health effects of a policy, programme, or project prior to implementation. HIA has gained significant attention in recent decades due to its utility in facilitating a broader understanding of health and bringing diverse stakeholders and evidence into decision-making processes. Despite this interest in HIA its implementation remains challenging within governance, decision making, and regulatory contexts. The authors used the Consolidated Framework for Implementation Research (CFIR) 2.0 as a methodological framework to identify potential factors influencing implementation of HIA from an implementation science perspective. The findings suggest that building wider HIA support, awareness, and capacity are essential to progressing HIA, and that this is also dependent on wider public health advocacy.
This policy brief emerges from a Sustainable HIV Prevention Initiative Convening held in Lilongwe, Malawi on February 18-19, 2025, hosted by the Government of Malawi. The brief presents priority recommendations for governments navigating external funding transitions, including strategies for increasing domestic and innovative financing mechanisms, accelerated integration of HIV services into national health systems and primary care, and ensuring continuation of people-centered HIV services including prevention for key and vulnerable populations. Drawing from the successful Blantyre Prevention Strategy model - a district-based approach that strengthens local institutional capacity for HIV prevention through data-driven decision making, quality improvement, and community engagement - the brief advocates for bold government actions to maintain progress toward ending AIDS as a public health threat by 2030 despite declining donor support.
This study examined pre-eclampsia management in Sierra Leone and Zambia, where the condition contributes significantly to maternal mortality (70% of 30,000 annual deaths occur in Sub-Saharan Africa). The authors implemented policy labs, a user-centric approach bringing together diverse stakeholders to integrate new evidence into care pathways. Working with the Policy Institute and local stakeholders, the labs focused on improving timely detection and early delivery strategies for pre-eclampsia cases. Participants identified lack of awareness as a key barrier and recommended locally co-designed community strategies to increase access to timely management. The policy lab approach proved effective in both settings for translating new knowledge into policy and action.
This qualitative pre-post evaluation study examined the transition to an electronic Research Ethics Information Management System at Muhimbili University through interviews with 16 faculty members with experience in both paper-based and electronic systems. Using thematic analysis, researchers identified key strengths including system convenience and improved records management. Limitations centered on demands for reliable information and communication technologies and reduced reviewer-researcher interaction. The findings underscore both benefits and challenges of implementing paperless systems in resource-limited settings, recommending system automation, strengthened institutional capacity, and further studies on system adoptability, particularly in resource-constrained environments.
This paper assessed the World Health Organization’s approaches to health equity in select health promotion, social determinants of health, and urban health texts from 2008 to 2016. The authors found that the World Health Organization usually measures health equity by comparing groups, explicitly specifies three approaches to health equity and considers health equity inconsistently both in terms of socioeconomic status and other social determinants of health. Socioeconomic status was given substantially more attention than other social determinants of health. The authors argue that there is misalignment with the World Health Organization’s stated approaches to tackle health inequity and its discourses around health equity. This incongruence, they argue, increases the likelihood of pursuing short-term solutions and not sustainably addressing the root causes of health inequity. They argue that critical discourse analysis’ focus on power allowed for an understanding of why ‘radical’ approaches are not explicitly expressed so that governments will be agreeable to addressing health inequity.
The world faces global health risks that need to be effectively addressed in integrated, participatory efforts. However, risk analysis frameworks do not account for the complex nature of systems that span multiple sectors or disciplines. The authors propose the participatory and interdisciplinary concept of risk negotiation to transform the way global health challenges such as pandemics, physical and mental health inequities, environmental problems and food security are tackled. To allow such risk analysis, there is a need to recognize the value of risks and trade-offs and negotiate them with stakeholder groups representing different disciplines and sectors. This approach becomes feasible through recent technological breakthroughs such as artificial intelligence-assisted multi-agent negotiations or large language models. These models are accessible, hold promise in negotiating agreements and can be used to accommodate the complexity of real-world decision-making.
Sub-Saharan Africa has the highest under-five mortality rate globally and child healthcare decisions should be based on rigorously developed evidence-informed guidelines. The Global Evidence, Local Adaptation (GELA) project is enhancing capacity to use global research to develop locally relevant guidelines for newborn and child health in South Africa (SA), Malawi, and Nigeria. The first step, described in this paper, identifies national priorities for newborn and child health guideline development. This followed a good practice method for priority setting, including stakeholder engagement, online priority setting surveys and consensus meetings, conducted separately in South Africa, Malawi and Nigeria. The authors established national Steering Groups, comprising 10–13 members representing government, academia, and other stakeholders, identified through existing contacts and references, who helped prioritise initial topics identified by research teams and oversaw the process. Various stakeholders were consulted via online surveys to rate the importance of topics, with results informing consensus meetings with Steering Groups where final priority topics were agreed. Through voting and discussion within meetings, and further engagement after the meetings, the top three priority topics were identified in each country. In South Africa, the topics concerned anemia prevention in infants and young children and post-discharge support for caregivers of preterm and low birth weight babies. In Malawi, they focused on nutrition in critically ill children, diagnosis of childhood cancers in the community, and caring for neonates. In Nigeria, the topics focused on identifying pre-eclampsia in the community, hand hygiene compliance to prevent infections, and nutrition for low both weight and preterm infants.
This paper compiles current evidence on barriers to uptake of research in health policy and practice in low- and middle-income countries using scoping review. A total of 4291 publications were retrieved in the initial search, of which 142 were included as meeting the eligibility criteria. Overall, research uptake for policy-making and practice in low- and middle-income countries was very low. The challenges to research uptake were related to lack of understanding of the local contexts, low political priority, poor stakeholder engagement and partnership, resource and capacity constraints, low system response for accountability and lack of communication and dissemination platforms. Important barriers to research uptake were identified, particularly limited contextual understanding and low participation of key stakeholders and ownership. The authors suggest improved understanding of the local research and policy context and participatory evidence production and dissemination to promote research uptake for policy and practice. Institutions that bridge the chasm between knowledge formation, evidence synthesis and translation are noted to potentially play critical role in this translation process.
The COVID-19 pandemic lockdown and restrictions on movement presented an opportunity to conduct Violence Against Women (VAW) research using remote methods. The authors discuss how they adapted methods, reflect on lessons learned, and make recommendations highlighting key considerations when conducting remote research on a sensitive topic of VAW. An exploratory qualitative study was designed using remote methods with 18 men and 19 women, aged 18 years and older, who lived with their partner or spouse during lockdown in South Africa. Data presented in this paper draws from researchers’ reflections drawn from debriefing sessions during the research process, and from participants’ interview transcripts. Remote recruitment of participants took longer than anticipated, and the authors had to re-advertise the study. The authors could not ensure safety and privacy during interviews. Regardless of all the safety and privacy measures the authors put in place during the research process, some participants had an adult person present in the room during interviews, and the researchers had no control over interruptions. Rapport was difficult to establish without an in-person connection, which limited disclosure about violence experience and perpetration. Given the methodological and ethical challenges which limited disclosure of violence against women remotely, the authors conclude that telephone interviews used in this study impacted on the quality of study data. Therefore, the authors do not recommend violence against women research to be conducted remotely, unless it is essential and participants are already known to the interviewer and trust has been established.