Monitoring equity and research policy

Open access: academic publishing and its implications for knowledge equity in Kenya
Matheka D, Nderitu J, Mutonga D, Otiti M, Siegel K and Demaio A: Globalization and Health (10)26, 2014

Traditional, subscription-based scientific publishing has its limitations: often, articles are inaccessible to the majority of researchers in low- and middle-income countries (LMICs), where journal subscriptions or one-time access fees are cost-prohibitive. Open access (OA) publishing, in which journals provide online access to articles free of charge, breaks this barrier and allows unrestricted access to scientific and scholarly information to researchers all over the globe. At the same time, one major limitation to OA is a high publishing cost that is placed on authors. Following recent developments to OA publishing policies in the UK and even LMICs, this article highlights the current status and future challenges of OA in Africa. The authors place particular emphasis on Kenya, where multidisciplinary efforts to improve access have been established. They note that these efforts in Kenya can be further strengthened and potentially replicated in other African countries, with the goal of elevating the visibility of African research and improving access for African researchers to global research, and, ultimately, bring social and economic benefits to the region. The authors (1) offer recommendations for overcoming the challenges of implementing OA in Africa and (2) call for urgent action by African governments to follow the suit of high-income countries like the UK and Australia, mandating OA for publicly-funded research in their region and supporting future research into how OA might bring social and economic benefits to Africa

Reclaiming public health through community-based monitoring: The case of Maharashtra, India
Shukla A, Saha Sinha S and SATHI: Municipal Services Project, September 2014

Community-based monitoring and planning (CBMP) of health services in Maharashtra state, India represents an innovative participatory approach to improving accountability and healthcare delivery. Supported by diverse stories of change, the paper shows how this process created various forums and spaces for dialogue and led to systematic data collection on health indicators that point to greater accessibility and quality of services at village as well as primary health centre levels. The authors ask whether this experience could inform ‘communitization’ of health services in diverse contexts, as an alternative to privatization and as a means to enhancing the ‘publicness’ of health services.

Assessing the ability of health information systems in hospitals to support evidence-informed decisions in Kenya
Kihuba E, Gathara D, Mwinga S, Mulaku M, Kosgei R, Mogoa W, Nyamai R, English M: Global Health Action, 7, July 2014.

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.

Fulfilling the Health Agenda for Women and Children: The 2014 Report
Countdown to 2015: Geneva June 2014

The 2014 Report, Fulfilling the Health Agenda for Women and Children, was released exactly 18 months to the day from the deadline for the Millennium Development Goals at the end of 2015. Like previous Countdown reports, it includes an updated, detailed profile for each of the 75 Countdown countries, which together account for more than 95% of the global burden of maternal, newborn and child death. The report shows that progress has been impressive in some areas, but it also highlights the vast areas of unfinished business that must be prioritized in the post-2015 framework. The 2014 Report also provides an assessment of the state of the data to support evidence-based decisions in women's and children's health, and describes elements of the Countdown process that might inform ongoing efforts to hold the world to account for progress. It concludes by laying out concrete action steps that can be taken now to ensure continued progress for women and children in the years ahead.

The Promise of Community-Based Participatory Research for Health Equity: A Conceptual Model for Bridging Evidence With Policy
Cacari-Stone L, Wallerstein N, Garcia AP, and Minkler M: Am J Public Health. Published online ahead of print e1–e9, July 17 2014

Insufficient attention has been paid to how research can be leveraged to promote health policy or how locality-based research strategies, in particular community-based participatory research (CBPR), influences health policy to eliminate racial and ethnic health inequities. To address this gap, the authors highlighted the efforts of two CBPR partnerships to explore how these initiatives made substantial contributions to policymaking for health equity. They present a new conceptual model and two case studies to illustrate the connections among CBPR contexts and processes, policymaking processes and strategies, and outcomes. They extended the critical role of civic engagement by those communities that were most burdened by health inequities by focusing on their political participation as research brokers in bridging evidence and policymaking.

Handbook on Health Inequality Monitoring: with a special focus on low- and middle-income countries
World Health Organization, Geneva, 2013.

The Handbook on health inequality monitoring: with a special focus on low- and middle-income countries is a user-friendly resource, developed to help countries establish and strengthen health inequality monitoring practices. The handbook elaborates on the steps of health inequality monitoring, including selecting relevant health indicators and equity stratifiers, obtaining data, analysing data, reporting results and implementing changes. Throughout the handbook, examples from low- and middle-income countries are presented to illustrate how concepts are relevant and applied in real-world situations; informative text boxes provide the context to better understand the complexities of the subject. The final section of the handbook presents an expanded example of national-level health inequality monitoring of reproductive, maternal and child health.

Mutual learning and reverse innovation - where next?
Crisp N: Globalization and Health 10(14): 28 March 2014

The papers argues for mutual learning in global health systems. The author argues that it is increasingly recognized that innovation needs to be sourced globally and that we need to think in terms of co-development as ideas are developed and spread from richer to poorer countries and vice versa. The Globalization and Health journal’s ongoing thematic series, “Reverse innovation in global health systems: learning from low-income countries” illustrates how mutual learning and ideas about so-called "reverse innovation" or "frugal innovation" are being developed and utilized by researchers and practitioners around the world. The path to truly “global innovation flow”, although not fully established, is argued to be under way. Global health learning laboratories, where partners can support each other in generating and sharing lessons, have the potential to construct solutions for the world. At the heart of this dialogue is a focus on creating practical local solutions and, simultaneously, drawing out the lessons for the whole world.

A practical and systematic approach to organisational capacity strengthening for research in the health sector in Africa
Bates I, Boyd A, Smith H and Cole D: Health Research Policy and Systems, 12:11; doi:10.1186/1478-4505-12-11, 2014

Despite increasing investment in health research capacity strengthening efforts in low and middle income countries, published evidence to guide the systematic design and monitoring of such interventions is very limited. Systematic processes are important to underpin capacity strengthening interventions because they provide stepwise guidance and allow for continual improvement. The authors aimed to use evidence to inform the design of a replicable but flexible process to guide health research capacity strengthening that could be customized for different contexts, and to provide a framework for planning, collecting information, making decisions, and improving performance. They used peer-reviewed and grey literature to develop a five-step pathway for designing and evaluating health research capacity strengthening programmes, tested in a variety of contexts in Africa. The five steps are: i) defining the goal of the capacity strengthening effort, ii) describing the optimal capacity needed to achieve the goal, iii) determining the existing capacity gaps compared to the optimum, iv) devising an action plan to fill the gaps and associated indicators of change, and v) adapting the plan and indicators as the programme matures. The five-step pathway starts with a clear goal and objectives, making explicit the capacity required to achieve the goal. Strategies for promoting sustainability are agreed with partners and incorporated from the outset. The pathway for designing capacity strengthening programmes focuses not only on technical, managerial, and financial processes within organisations, but also on the individuals within organisations and the wider system within which organisations are coordinated, financed, and managed.

Health policy and systems research in access to medicines: a prioritized agenda for low- and middle-income countries
Bigdeli M, Javadi D, Hoebert J, Laing R, Ranson K and The Alliance for Health Policy and Systems Research: Health Research Policy and Systems 11(37): 2013

To identify priority policy issues in access to medicines (ATM) relevant for low- and middle-income countries, to identify research questions that would help address these policy issues, and to prioritize these research questions in a health policy and systems research (HPSR) agenda. The study involved i) country- and regional-level priority-setting exercises performed in 17 countries across five regions, with a desk review of relevant grey and published literature combined with mapping and interviews of national and regional stakeholders; ii) interviews with global-level stakeholders; iii) a scoping of published literature; and iv) a consensus building exercise with global stakeholders which resulted in the formulation and ranking of HPSR questions in the field of ATM. A list of 18 priority policy issues was established following analysis of country-, regional-, and global-level exercises. Eighteen research questions were formulated during the global stakeholders’ meeting and ranked according to four ranking criteria (innovation, impact on health and health systems, equity, and lack of research). The top three research questions were: i) In risk protection schemes, which innovations and policies improve equitable access to and appropriate use of medicines, sustainability of the insurance system, and financial impact on the insured? ii) How can stakeholders use the information available in the system, e.g., price, availability, quality, utilization, registration, procurement, in a transparent way towards improving access and use of medicines? and iii) How do policies and other interventions into private markets, such as information, subsidies, price controls, donation, regulatory mechanisms, promotion practices, etc., impact on access to and appropriate use of medicines?The authors' HPSR agenda adopts a health systems perspective and will guide relevant, innovative research, likely to bear an impact on health, health systems and equity.

Science for health diplomacy: complex problems need complex solutions
Rinaldi A: COHRED, February 28 2014

Almost any major problem in global health – from discovering new drugs to developing vaccines, to finding solutions to environmental changes that can affect health in vulnerable countries – requires research and innovation solutions that are beyond the scope of individual countries, organisation, or companies. In the case of research and innovation for health, there are few, if any, functional platforms where multiple players can negotiate towards creating constructive solutions, or share global resources better. COHRED outlines opportunities to play a role in the complex array of partners, with attention to Africa, enabling sustainable and usually complex solutions for complex global health problems.