Monitoring equity and research policy

The West African Health Organization’s experience in improving the health research environment in the ECOWAS region
Aidam J; Sombié I: Health Research Policy and Systems14(30), 20 April 2016

The West African Health Organization (WAHO) implemented a research development program in West Africa during 2009–2013 with components of stewardship, financing, sustainable resourcing and research utilization. This paper describes how programme and lessons learnt, triangulating activity reports, an independent evaluation and the authors’ experiences with stakeholders. WAHO and major stakeholders validated these findings during a regional meeting. All 15 ECOWAS countries benefited from this regional research development programme. WAHO provided technical and financial support to eight countries to develop their policies, priorities and plans for research development to improve their research governance and organised capacity-strengthening training in health systems research methodology, resource mobilization, ethical oversight and on HRWeb, a research information management platform. WAHO helped launch a regional network of health research institutions to improve collaboration between regional participating institutions and mobilised funding for the programme. It supported 24 health research projects. High staff turnover, weak institutional capacities and ineffective collaboration were some of the challenges encountered during implementation. The regional collaborative approach to health research was found to be effective given the challenges in the region, and with research partnerships and funding helped strengthen local health research environments.

Framework for monitoring equity in access and health systems issues in antiretroviral therapy Programmes in southern Africa
Kalanda B; Kemp J; Makwiza I: Malawi Medical Journal19(1) 20–24, 2007

Universal provision of antiretroviral therapy (ART), while feasible, is expensive. In light of this limitation, the World Health Organisation (WHO) has launched the 3 × 5 initiative, to provide ART to 3 million people by the end of the year 2005. In Southern Africa, large-scale provision of ART will likely be achieved through fragile public health systems. ART programmes should therefore be developed and expanded in ways that will not aggravate inequities or result in the inappropriate withdrawal of resources from other health interventions or from other parts of the health system. This paper, proposes a framework for monitoring equity in access and health systems issues in ART programmes in Southern Africa. It proposes that an equity monitoring system should comprise seven thematic areas. These thematic areas encompass a national monitoring system which extends beyond one agency or single data collection method. Together with monitoring of targets in terms of numbers treated, there should also be monitoring of health systems impacts and issues in ART expansion, with reporting both nationally and to a regional body.

Measuring Regional Policy Change and pro-Poor Health Policy Success: A PRARI Toolkit of Indicators for the Southern African Development Community
Amaya A; Choge I; De Lombaerde P; et al.,: UNU CRIS, Open University, December 2015

Developed collaboratively with actors in the region, this toolkit is a guide to the implementation of an indicator system to measure regional policy change and pro-poor regional health policy successes targeted at the pilot areas of HIV/AIDS, TB and malaria in the SADC context. The toolkit also aims to capture the limitations the health sectors in many countries may have in addressing structural issues that make the poor more vulnerable or at risk.

Evidence-informed policymaking in practice: country-level examples of use of evidence for iCCM policy
Rodríguez D; Shearer J; Mariano A; Juma P; Dalglish S; Bennet S: Health Policy and Planning 30 (suppl 2): ii36-ii45, December 2015

Integrated Community Case Management of Childhood Illness (iCCM) is a policy for providing treatment for malaria, diarrhoea and pneumonia for children below 5 years at the community level, which is generating increasing evidence and support at the global level. This article explores whether, how and why evidence influenced policy formulation for iCCM in Niger, Kenya and Mozambique, and explains the use of evidence in these contexts. Findings indicate that all three countries used national monitoring data to identify the issue of children dying in the community prior to reaching health facilities, whereas international research evidence was used to identify policy options. Nevertheless, policymakers greatly valued local evidence and pilot projects proved critical in advancing iCCM. World Health Organisation and United Nations Children's Fund (UNICEF) functioned as knowledge brokers, bringing research evidence and experiences from other countries to the attention of local policymakers as well as sponsoring site visits and meetings. Both Mozambique and Kenya exhibit Problem-Solving research utilisation with different outcomes.

District Health Barometer, South Africa 2014/15
Massyn N; Peer N; Padarath A; Barron P; Day C: Health Systems Trust, 2015

The annually published District Health Barometer (DHB) in South Africa is designed and compiled to assist South Africa’s National Department of Health in making health and related information available for monitoring progress in health service delivery at district level. The Barometer provides current information on functioning and associated fluctuations in all the country’s health districts, describing performance over time in relation to previous years as well as between districts. Each edition highlights problem areas, data quality issues, sustained and notable progress, and aspects requiring deeper research into underlying factors contributing to the indicator values and trends. This 10th edition of the DHB presents data on 44 indicators, with trend illustrations and health profiles for South Africa as a whole, the nine provinces and the 52 districts, as well as a chapter on the country’s burden of disease. As in previous years, a varied picture emerges in terms of the national profile. Significant gains are noted in the rates of stillbirth; early mother-to-child transmission of HIV; cure among new pulmonary smear-positive TB patients; couple year protection; women under age 18 delivering babies in hospital; case fatality among children under five years of age from diarrhoea with dehydration and from pneumonia; and antenatal clients initiated on ART. However, persistent challenges prevail with regard to the Caesarean section rate in district hospitals, the school Grade 1 screening coverage, the measles 2nd dose coverage, and the case fatality rate for severe acute malnutrition in children under five years of age.

Declaration of the 3rd World Social Science Forum
Council for the Development of Social Science Research in Africa (CODESRIA): September 2015

The World Social Science Forum 2015 served as a platform for presenting new knowledge and insights, re-thinking received wisdom, charting new directions, promoting innovation in the research-policy-action nexus, and nurturing new international partnerships. Issues of justice and growing inequalities at global, regional, national and local levels and their impact on the quality of life of populations as well as on the sustainability of resources justified the theme: 'Transforming Global Relations for a Just World'. Participants declared their concern with the consequences of injustice and inequality for the quality of life for global populations as well as with the sustainability of global resources. The participants declared to: (a) Pursue theoretical and empirical research including development of reliable and multi-dimensional indicators on inequalities and injustices; (b) Produce evidence to highlight issues requiring urgent attention and action, support advocacy and inform policies to respond to them; (c) Support efforts to address asymmetries, disparities, divides, and lack of autonomy in knowledge production through the creation of transformative knowledge programs; (d) Participate in programs and efforts that aim to end injustice and inequality; (e) Make every effort to reduce income inequalities and promote equity, starting with scientific institutions where they have influence; (f) Support measurable progress to overcome inequalities, including through the implementation of the Sustainable Development Goals; (g) Promote policies, programs, and values that act to end gender inequality; (h) Promote the integration of youth in work places through providing them with the necessary skills to enter the labour force; (i) Support efforts to achieve legally binding and universal agreement on avoiding dangerous anthropogenic interference with the climate system; and (j) Promote inclusive societies based on universal values and human rights.

Africa Analysis: Welcoming African science home
Nordling L: SciDevNet, 18 September 2015

The new Alliance for Accelerating Excellence in Science in Africa (AESA) was launched on the 10th of September 2015 in Nairobi, Kenya. AESA, which is hosted at AAS headquarters in Nairobi, is intended to bring the centre of gravity for health research funding decision-making from places such as Seattle in the United States and London in the United Kingdom to Africa itself. Its African backers include the New Partnership for Africa’s Development, a continental policy implementation agency. Three big international research funders — the UK-based Wellcome Trust, the UK's Department for International Development (DFID) and the Bill and Melinda Gates Foundation in the United States — have earmarked funding programmes that they plan to let AESA administer. From next year, AESA is expected to take over the management of the Wellcome Trust's five-year US$70 million DELTAS programme, which involves seven new African centres of health research and training excellence in subjects ranging from biostatistics to mental health in six African countries: Ghana, Kenya, Mali, South Africa, Uganda and Zimbabwe.

The individual household method
Evidence for Development: UK, 2015

The individual household method (IHM) provides estimates of household income, with detailed information on household assets, demography and specific income sources. This data can be used to support the design and evaluation of programmes, and seeks to collect information on actual households directly from their members. This enables IHM studies to identify more complex variation across populations and to model the impact of changes on a much wider range of population groups, with data disaggregated by demographics (gender and age), income levels and other chosen characteristics.

How many people lack access to health care? (Hint: More than WHO and the World Bank report)
Freidman E: O Neil Institute, August 2015

A recent World Bank press release on a World Bank and WHO report announced that "400 million people do not have access to essential health services.” The author argues in this article that this would be a highly over-optimistic misread of what WHO and the World Bank found. By more reasonable understandings of how many people lack access to essential health services, untold hundreds of millions more than 400 million people lack access to essential health services. He notes that the road ahead to universal health coverage is considerably longer than the headline figure implies. The report itself – beneath the headlines – covers many concerns and raises issues of quality and other concerns in a more complex reality. The author of this article notes that official monitoring should capture this complexity as what is monitored may well affect what governments prioritize, and the health services people actually receive, and so that a singular focus on access does not hide other aspects of people’s right to health – including the quality of health services and their acceptability.

Research on health inequalities: A bibliometric analysis (1966–2014)
Bouchard L, Albertini M, Batista R, de Montigny J: Social Science & Medicine, 141, 100-108, 2015

This study reported on research production and publications on health inequalities through a bibliometric analysis covering publications from 1966 to 2014 and a content analysis of the 25 most-cited papers. A database of 49,294 references was compiled from the search engine Web of Science. The first article appears in 1966 and deals with equality and civil rights in the United States and the elimination of racial discrimination in access to medical care. By 2003, the term disparity has gained in prominence relative to the term inequality which was initially elected by the researchers. The paper shows that research on health inequalities grown exponentially in the last 30 years; the terms inequity, inequality and disparity have been inconsistently used over time; the most-cited papers studied socioeconomic factors and impacts on health inequities with first reports studying relations of socioeconomic conditions and health outcomes and research growing toward theoretical models and proposals on methodological approaches.