Unless African governments increase their funding for and engagement in HIV research, the continent cannot hope to attain equal status in determining its research agenda and priorities, speakers said at the 16th International Conference on AIDS and Sexually Transmitted Infections (STIs) in Africa, held in December 2011 in Ethiopia. Most African health research is driven by external funders, which often means that research starts and ends on the say-so of the funders, rather than being based on a country's needs. Prof Nelson Sewankambo, principal of the College of Health Sciences at Uganda's Makerere University, said heavy external funder involvement in local research can actually harm existing national institutions, which may lose strategic direction and become retarded by the loss of key staff to research projects and distortion of institutional structures and governance. He argued that inequities in collaboration can lead to lack of transparency in the decision-making process, as well as disputes over publication rights, ownership of data, specimens and equipment. Other speakers also noted that inadequate community engagement was common when partnerships were skewed in favour of funders’ priorities and ethical violations occurred in research projects, such as the use of placebos in studies on mother-to-child HIV transmission. They called for new, more equitable partnership models and expansion of local capacity to sustain research activities once externally funded projects ended.
Monitoring equity and research policy
In the context of recent global calls for strengthening the field of health policy and systems research (HPSR) as a critical input to strengthening health systems, the authors of this paper assessed the extent to which progress has been achieved in this regard. Two sources of data were used: a bibliometric analysis to assess growth in production of HPSR between 2003 and 2009, and a 2010 survey of 96 research institutions to assess capacity and funding availability to undertake HPSR. Both analyses focused on HPSR relevant to low-income and middle-income countries (LMICs). Overall, the authors found an increasing trend of publications on HPSR in LMICs, although only 4% were led by authors from low-income countries (LICs). Improvements were noted in infrastructure of research institutions in LICs, but more limited gains in the level of experience of researchers within institutions. There has been only a modest increase in availability of funding for LICs.
This is the third of a series of three papers addressing the current challenges and opportunities for the development of Health Policy and Systems Research (HPSR). The authors of this paper assert that there is an urgent need to build the Health Policy and Systems Research (HPSR) field and in particular to develop understanding across different disciplinary boundaries. The development of HPSR is impeded by a cluster of related issues: a heavy reliance on international funding for HPSR; an excessive focus on the direct utility of HPSR findings from specific studies; and a tendency to under-value contributions to HPSR from social sciences. Innovations in funding HPSR are needed so that local actors, including policy-makers, civil society, and researchers, have a greater say in determining the nature of HPSR conducted. Strategic investment should be made in promoting a greater shared understanding of theoretical frames and methodological approaches for HPSR including, for example, the development of HPSR journals, methodological workshops, and shared HPSR teaching curricula. Dedicated and supportive homes for HPSR need to be found within universities, and also be developed as independent research institutes, the authors conclude.
This is the first of a series of three papers addressing the current challenges and opportunities for the development of Health Policy and Systems Research (HPSR). HPSR is a multidisciplinary and interdisciplinary field identified by the topics and scope of questions asked rather than by methodology. The focus of discussion is HPSR in low- and middle-income countries. Topics of research in HPSR include international, national, and local health systems and their interconnectivities, and policies made and implemented at all levels of the health system. Research questions in HPSR vary by the level of analysis (macro, meso, and micro) and intent of the question (normative/evaluative or exploratory/explanatory). Current heightened attention on HPSR contains significant opportunities, but also threats in the form of certain focus areas and questions being privileged over others; “disciplinary capture” of the field by the dominant health research traditions; and premature and inappropriately narrow definitions. The authors call for greater attention to fundamental, exploratory, and explanatory types of HPSR; to the significance of the field for societal and national development, necessitating HPSR capacity building in low- and middle-income countries; and for greater literacy and application of a wide spectrum of methodologies.
This is the second of a series of three papers addressing the current challenges and opportunities for the development of Health Policy and Systems Research (HPSR). According to this paper, all researchers hold a knowledge paradigm that frames their understanding of reality and of the functions and nature of research. Some disciplines are dominated by a particular paradigm and some are spread across paradigms. The criticisms that Health Policy and Systems Research (HPSR) is too context specific, does not offer clear lessons for policy makers, and is not rigorous are partly a reflection of differences in knowledge paradigms between those with predominantly clinical, biomedical, and epidemiological backgrounds, underpinned by a positivist paradigm, and those with social science backgrounds underpinned by a relativist paradigm. Health policies and systems are complex social and political phenomena, constructed by human action rather than naturally occurring. Therefore, the authors argue, relativist social science perspectives are of particular relevance to HPSR as they recognise that all phenomena are in essence constructed through human behaviour and interpretation. Social science insights that can advance the science of HPSR include: approaches to generalising from rich understanding of context; supporting policy learning; and enhancing research rigour and quality.
In South Africa, the number of papers produced in health and rehabilitation sciences is insignificant compared with other health-related disciplines, according to the authors of this paper. To identify strategies to increase the number of these papers, the authors reviewed published papers that examined the effectiveness of interventions designed to promote research publications among academics and clinicians in health and rehabilitation sciences programmes. Seven of the papers reported on interventions for academics, and six reported on the interventions for academics in the nursing profession. The most common interventions were ‘writing support groups’, ‘writing retreats’, and ‘writing courses’ that lasted from three days to five years. The interventions were designed to meet the needs of the participants for structured time, motivation, improved writing skills and peer support. All the interventions produced significant research output relating to submission or publication of academic papers. The implementation of these interventions by South African tertiary institutions where health and rehabilitation sciences are offered may improve the number of papers published by the health research community, the authors conclude.
In this article, the author argues that international agreements and planning instruments such as the World Bank’s Poverty Reduction Strategy Papers (PRSPs) often fail to question the parameters within which national plans are prepared. Home grown solutions can only be produced from knowledge and policies that are locally generated and context specific. Southern knowledge centres (or think tanks) – which are estimated to number about 2,000 – then have a crucial role to play in promoting economic and social development in the global South, particularly in the poorer economies. In an increasingly interconnected world, Northern and Southern think tanks are joining forces in partnerships and networks to generate and use knowledge more systematically to address national, regional, and global challenges. A number of examples of North-South collaborations are discussed in the article, including the Chronic Poverty Research Centre and the Climate and Development Knowledge Network. Networks of think tanks can provide an extremely effective mechanism for learning and innovation, the author notes, and they can enable collaboration beyond the usual institutional, cultural, and functional boundaries of an organisation.
Despite the benefits to collaborative approaches and sharing of best practices, none of this can take place in the absence of adequate funding, the authors of this article argue. They call for re-examination of funding initiatives that bypass academic institutions because of a reluctance to fund ‘Ivory Tower’ initiatives. Recent initiatives will invest approximately US$130 million over the next five years to strengthen Africa’s educational institutions to produce the quantity and quality of scientists and health care workers needed to address the healthcare problems in the region. Whereas this represents a step in the right direction, substantially more funding will be required, including funding from the African governments themselves, to address national health priorities. The authors challenge conventional notions that academia is hesitant to come down from their ivory towers. Universities can and must be socially relevant. Funding and investments are needed now to make these collaborations sustainable, they conclude.
Complementary medicine research, including naturopathic medicine research, is plagued with many methodological challenges, the authors of this paper argue. Many of these challenges have also been experienced in public health research. Public health research has met these challenges with a long history of multidisciplinary, multimethod, and whole systems approaches to research that may better resonate with the “real world” clinical settings of naturopathic medicine. Additionally, many of the underlying principles of naturopathic medicine are analogous to the underlying principles and activities of public health, specifically in such areas as health promotion, prevention, patient education, and proactive rather than reactive approaches to disease management and treatment. Future research in the field of naturopathic medicine may benefit from adopting public health research models rather than focusing exclusively on biomedical models, the authors argue. A complementary and collaborative relationship between these fields may provide an opportunity to deliver research that more accurately reflects naturopathic medicine practice, as well as providing the opportunity to improve health outcomes more generally.
At the Berlin 9 conference, held in Washington DC, United States from 9-10 November 2011, it was announced that 33 research institutions, associations and foundations in North America have added their signatures to the Berlin Declaration on Open Access to Knowledge in the Sciences and Humanities, committing to support open access research in the future. The signing brings the total signatories to nearly 300, including many of the top research institutions in the world. The Berlin Declaration aims to ‘make scientific and scholarly research more accessible to the broader public by taking full advantage of the possibilities offered by digital electronic communication.’